Related Experiment Video
Updated: Aug 25, 2025
Author Spotlight: Simulating Pediatric Cardiac Surgery Using a Neonatal Piglet Model
Published on: May 26, 2023
Pre-hospital CPR after traumatic arrest: Outcomes at a level 1 pediatric trauma center
Shai Stewart1, Kayla B Briggs1, James A Fraser1
1Department of Surgery, Children's Mercy Hospital, United States; School of Medicine, Kansas City University, United States.
Insights
Outcomes for children with traumatic cardiopulmonary arrest (TCA) requiring pre-hospital cardiopulmonary resuscitation (P-CPR) are poor, especially for those without return of spontaneous circulation (ROSC). Standardized resuscitation guidelines are needed.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Surgery
- Critical Care
Background:
- Traumatic cardiopulmonary arrest (TCA) in children requiring pre-hospital cardiopulmonary resuscitation (P-CPR) has extremely low survival rates.
- Understanding injury mechanisms and outcomes is crucial for improving pediatric TCA survival.
Purpose of the Study:
- To describe the mechanisms of injury and outcomes of children experiencing TCA requiring P-CPR.
- To analyze survival rates based on pre-hospital return of spontaneous circulation (ROSC).
Main Methods:
- Retrospective review of pediatric patients (0-17 years) with TCA and P-CPR from 5/2009 to 3/2020.
- Patients stratified into two groups: those in CPR upon arrival and those with pre-hospital ROSC.
- Primary outcome was survival to hospital discharge.
Main Results:
- 48 children experienced TCA requiring P-CPR; 23 achieved pre-hospital ROSC.
- None of the 25 children undergoing CPR at presentation survived to discharge.
- 6 of 23 children with pre-hospital ROSC survived; all survivors had residual deficits.
Conclusions:
- Children with pre-hospital TCA have poor outcomes, particularly those without pre-hospital ROSC.
- Findings highlight the urgent need for standardized resuscitation guidelines for pediatric traumatic arrest.
- Further research into optimal management strategies for pediatric TCA is warranted.
Background:
The survival of traumatic cardiopulmonary arrest (TCA) requiring pre-hospital cardiopulmonary resuscitation (P-CPR) is abysmal across age groups. We aim to describe the mechanisms of injury and outcomes of children suffering from TCA leading to P-CPR at our institution.
Methods:
A retrospective review was conducted to identify children ages 0-17 years who suffered TCA leading to P-CPR at our institution between 5/2009 and 3/2020. For analysis, patients were stratified into those still undergoing CPR at arrival and those who attained pre-hospital return of spontaneous circulation (ROSC). Primary outcome was discharge alive from the hospital.
Results:
P-CPR was initiated for 48 patients who had TCA; 23 had pre-hospital ROSC. Of the 25 children undergoing CPR at presentation, none survived to discharge. The median duration of CPR, from initiation to time of death declaration was 34 min [29,50]. Seventeen patients died after resuscitation attempts in the ED, while 8 died after admission to the PICU. Of the 23 patients who attained pre-hospital ROSC, 6 survived to discharge. All survivors required intensive rehabilitation services at discharge and at most recent follow-up, 5 had residual deficits requiring medical attention.
Conclusion:
There are poor outcomes in children with pre-hospital traumatic cardiopulmonary arrest, particularly in those without pre-hospital ROSC. These data further support the need for standardized guidelines for resuscitation in children with traumatic cardiopulmonary arrest.
Related Concept Videos
01:21Cardiopulmonary Resuscitation I: Adult
01:25Cardiopulmonary Resuscitation IV: Pharmacological Management
01:23Cardiopulmonary Resuscitation III: AED Use
01:22Cardiopulmonary Resuscitation II: ACLS Airway Management
01:26Flail Chest-II
Assessment:
1. Clinical Evaluation:
History: