Traumatic cardiac arrest is known to have a poor outcome, and some authors have stated that attempted resuscitation from traumatic cardiac arrest is futile. However, advances in damage control resuscitation and understanding of the differences in pathophysiology of traumatic cardiac arrest compared to medical cardiac arrest have led to unexpected survivors. Recently published data have suggested that outcome from traumatic cardiac arrest is no worse than that for medical causes of cardiac arrest, and in some groups may be better. This review highlights key areas of difference between traumatic cardiac arrest and medical cardiac arrest, and outlines a strategy for the management of patients in traumatic cardiac arrest. Standard Advanced Life Support algorithms should not be used for patients in traumatic cardiac arrest.
In attempt to standardise our approach to the management of paediatric TCA and to improve outcomes, we present the first consensus-based algorithm specific to the paediatric population. While this algorithm was developed for adoption in the UK, it may be applicable to similar healthcare systems internationally.
This study has given a consensus-based framework to guide protocol development in the management of paediatric TCA, though further work is required in other key areas including its acceptability to clinicians.
The majority of these patients recover from their injury, but a small proportion with normal CT scans have considerable disability 12 months after injury. Appropriate advice should be given to these patients to enable them to access further investigation and treatment.
This study demonstrates that the outcomes for paediatric TCA in our military field hospitals were similar to other paediatric civilian and adult military studies, despite patients being injured by severe blast injuries. Further work is needed to define the optimal management of paediatric TCA.
BackgroundPaediatric traumatic cardiac arrest (TCA) is associated with low survival and poor outcomes. The mechanisms that underlie TCA are different from medical cardiac arrest; the approach to treatment of TCA may therefore also need to differ to optimise outcomes. The aim of this study was to explore the opinion of subject matter experts (SMEs) regarding the diagnosis and treatment of paediatric TCA, and to reach consensus on how best to manage this group of patients.MethodsFollowing topic-specific literature reviews which demonstrated a lack of evidence, an online Delphi study was conducted over three rounds, with the aim of achieving consensus (defined as 70% agreement) on statements related to the diagnosis and management of paediatric TCA. SMEs were invited from PERUKI, (Paediatric Emergency Research in the UK and Ireland), paediatric major trauma centre leads, paediatric anaesthetists, paediatric ICU clinicians, paediatric surgeons, and representatives from the Resuscitation Council UK. Statements were informed by the literature reviews and were based on elements of Advanced Paediatric Life Support resuscitation algorithms as well as some concepts used in the management of adult TCA; they ranged from confirmation of cardiac arrest to the indications for thoracotomy.Results73 SMEs completed all three rounds between June and November 2016. Consensus has been reached on 14 statements regarding the diagnosis and management of paediatric TCA.ConclusionPaediatric TCA is one of the most challenging presentations that we face in paediatric emergency medicine. This study has given a consensus-based framework to guide protocol development in the management of paediatric TCA, though further work is required in other key areas including its acceptability to clinicians. A consensus dissemination meeting will be held in March 2017 where those statements which came close to consensus will also be discussed.
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