Presenter Status
Fellow
Abstract Type
Research
Primary Mentor
Tolulope A. Oyetunji, MD MPH FACS FAAP
Start Date
12-5-2021 11:30 AM
End Date
12-5-2021 1:30 PM
Presentation Type
Poster Presentation
Description
Background: The survival of traumatic cardiopulmonary arrest (TCA) requiring pre-hospital cardiopulmonary resuscitation (P-CPR) is abysmal across age groups.
Objectives/Goal: We aim to describe the patterns of injury, pre-hospital interventions, and outcomes of children suffering from TCA leading to P-CPR at our institution to support standardized guidelines addressing the termination of prolonged resuscitation attempts in children.
Methods/Design: Following IRB approval, retrospective review was conducted to identify children ages 0-17 years who suffered TCA leading to P-CPR at our institution between 5/1/2009–3/1/2020. 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. Secondary outcomes included length of treatment and neurologic outcomes. Analysis was performed using STATA®, a p-value of
Results: 48 children came to our facility after having P-CPR initiated for TCA (Table 1). Drownings were not included unless the trauma team was involved. 48% had pre-hospital ROSC. Of the 25 children who were undergoing CPR at presentation, none survived to discharge. 68% died after resuscitation attempts in the emergency department (median CPR time to death 34 minutes [29,50]) and 32% died after admission to the pediatric intensive care unit (median length of stay to death 24.5 hours [15,41.5]). Of the 23 children who attained pre-hospital ROSC, 26% survived to discharge (median length of stay 38 days [9,49], p=0.002). All 6 children required rehabilitation services at discharge and at most recent follow-up, 83% had residual deficits requiring medical attention but were partially independent with family support.
Conclusions: These data further describe the poor outcomes in children with pre-hospital traumatic cardiopulmonary arrest, particularly in those without pre-hospital return of spontaneous circulation. Further study is ongoing to determine the cost and emotional impact of these seemingly futile resuscitation attempts.
MeSH Keywords
Return of Spontaneous Circulation; Medical Futility; Intensive Care Units, Pediatric; Emergency Service, Hospital; Cardiopulmonary Resusitation
Additional Files
Pre-Hospital Traumatic Cardiopulmonary Arrest in Children at a Le.pdf (380 kB)Abstract
Included in
Pre-Hospital Traumatic Cardiopulmonary Arrest in Children at a Level 1 Pediatric Trauma Center
Background: The survival of traumatic cardiopulmonary arrest (TCA) requiring pre-hospital cardiopulmonary resuscitation (P-CPR) is abysmal across age groups.
Objectives/Goal: We aim to describe the patterns of injury, pre-hospital interventions, and outcomes of children suffering from TCA leading to P-CPR at our institution to support standardized guidelines addressing the termination of prolonged resuscitation attempts in children.
Methods/Design: Following IRB approval, retrospective review was conducted to identify children ages 0-17 years who suffered TCA leading to P-CPR at our institution between 5/1/2009–3/1/2020. 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. Secondary outcomes included length of treatment and neurologic outcomes. Analysis was performed using STATA®, a p-value of
Results: 48 children came to our facility after having P-CPR initiated for TCA (Table 1). Drownings were not included unless the trauma team was involved. 48% had pre-hospital ROSC. Of the 25 children who were undergoing CPR at presentation, none survived to discharge. 68% died after resuscitation attempts in the emergency department (median CPR time to death 34 minutes [29,50]) and 32% died after admission to the pediatric intensive care unit (median length of stay to death 24.5 hours [15,41.5]). Of the 23 children who attained pre-hospital ROSC, 26% survived to discharge (median length of stay 38 days [9,49], p=0.002). All 6 children required rehabilitation services at discharge and at most recent follow-up, 83% had residual deficits requiring medical attention but were partially independent with family support.
Conclusions: These data further describe the poor outcomes in children with pre-hospital traumatic cardiopulmonary arrest, particularly in those without pre-hospital return of spontaneous circulation. Further study is ongoing to determine the cost and emotional impact of these seemingly futile resuscitation attempts.
