Pediatric injuries from cardiopulmonary resuscitation

To assess the type, rate, and severity of unanticipated complications of CPR (external cardiac compressions and ventilation) in a pediatric population.

A retrospective review was undertaken of the records from all deceased children ( < 12 years old) who had been given CPR during an 8-year period (1988 through 1995). Patients with historical or physical evidence of preceding trauma were excluded. Clinical and autopsy records were abstracted for patient demographics, clinical findings, duration of CPR, persons administering CPR, and medical examiner summaries.

Two hundred eleven children (mean age, 19.0 months) met the inclusion criteria and were entered into the study. The most common cause of cardiac arrest was sudden infant death syndrome (56%), followed by drowning (8%), congenital heart disease (7%), and pneumonia (4%). Mean duration of CPR was 45 minutes (range, 3 to 180 minutes). Fifteen children (7%) had at least one injury as a result of CPR; 7 (3%) had injuries that were considered medically significant. These included retroperitoneal hemorrhage (n = 2), pneumothorax (n = 1), pulmonary hemorrhage (n = 1), epicardial hematoma (n = 1), and gastric perforation (n = 1); in spite of prolonged resuscitation performed with variable degrees of skill, only one patient was noted to have rib fractures.

Significant iatrogenic injuries are rare in children who receive CPR; they occur in approximately 3% of cases. Recognizing the possibility of a complication may help in the management of children who survive cardiac arrest. Regardless of resuscitation history, abuse should be considered whenever traumatic injuries are encountered.