Efficacy of cardiopulmonary resuscitation in pulseless paediatric trauma patients

Abstract

Background: A study was designed to determine which paediatric trauma patients with no detectable vital signs are likely to benefit from cardiopulmonary resuscitation (CPR). Methods: A 10-year retrospective study of all pulseless patients under 16 years of age with trauma in whom CPR was initiated in a prehospital or in-hospital setting in Southern Finland. Results: Forty-one patients, 25 male and 16 female, were included in this study. The mean age was 7.8 years (range 0.1–15.9 years). Twenty three patients had blunt injuries and three patients had penetrating injuries. The mean Injury Severity Score was 51 (range 25–75). In 15 patients, the arrest was secondary to smoke inhalation, strangulation or electric shock. Resuscitation was initiated at the scene or en route in 28 patients and in 13 patients at the hospital. Five patients received open-chest CPR and 36 patients closed-chest CPR. Spontaneous circulation was restored in four patients with open-chest CPR and in six patients with closed-chest CPR. Two patients had intact survival and one patient survived with moderate disability. The mechanism of traumatic cardiac arrest, initial cardiac rhythm or location of arrest did not seem to affect outcome of CPR. Conclusions: The overall survival rate of paediatric patients with cardiac arrest secondary to trauma is poor. Trauma patients in whom cardiac arrest is caused by respiratory arrest or by thoracoabdominal trauma in the hospital setting may have a chance of survival if a spontaneous circulation is rapidly restored with effective resuscitative measures.