ObjectiveTo describe the epidemiology and aetiology of paediatric traumatic cardiac arrest (TCA) in England and Wales.DesignPopulation-based analysis of the UK Trauma Audit and Research Network (TARN) database.Patients and settingAll paediatric and adolescent patients with TCA recorded on the TARN database for a 10-year period (2006–2015).MeasuresPatient demographics, Injury Severity Score (ISS), location of TCA (‘prehospital only’, ‘in-hospital only’ or ‘both’), interventions performed and outcome.Results21 710 paediatric patients were included in the database; 129 (0.6%) sustained TCA meeting study inclusion criteria. The majority, 103 (79.8%), had a prehospital TCA. 62.8% were male, with a median age of 11.7 (3.4–16.6) years, and a median ISS of 34 (25–45). 110 (85.3%) had blunt injuries, with road-traffic collision the most common mechanism (n=73, 56.6%). 123 (95.3%) had severe haemorrhage and/or traumatic brain injury. Overall 30-day survival was 5.4% ((95% CI 2.6 to 10.8), n=7). ‘Pre-hospital only’ TCA was associated with significantly higher survival (n=6) than those with TCA in both ‘pre-hospital and in-hospital’ (n=1)—13.0% (95% CI 6.1% to 25.7%) and 1.2% (95% CI 0.1% to 6.4%), respectively, p<0.05. The greatest survival (n=6, 10.3% (95% CI 4.8% to 20.8%)) was observed in those transported to a paediatric major trauma centre (MTC) (defined as either a paediatric-only MTC or combined adult-paediatric MTC).ConclusionsSurvival is possible from the resuscitation of children in TCA, with overall survival comparable to that reported in adults. The highest survival was observed in those with a pre-hospital only TCA, and those who were transported to an MTC. Early identification and aggressive management of paediatric TCA is advocated.

Computer-automated ECG screening for HCM is feasible. Evaluation of automated ECG algorithms in larger and more diverse populations is warranted.

IntroductionTraumatic cardiac arrest (TCA) has traditionally been described as futile, with poor outcomes. Reported survival rates vary widely, with higher rates observed from mechanisms leading to a respiratory cause of traumatic cardiac arrest (e.g., drowning and hanging). Currently there is little evidence regarding outcomes following TCA in children. The primary aim of our study was to describe 30 day survival following TCA. Secondary aims were to provide an analysis of injury patterns (severe haemorrhage or traumatic brain injury), describe the functional outcome at discharge and to report the association between survival and interventions performed.MethodsUsing the Trauma Audit and Research Network (TARN) database, we conducted a population-based analysis of all paediatric (<18 years) trauma patients presenting to hospitals in England and Wales between 2006–2015. Patients with TCA in the pre-hospital setting and/or in the Emergency Department were included. Those without a GCS entry were excluded. Basic demographics are reported as number (%) and median (interquartile range), as appropriate. Survival odds ratios (95%CIs) and Chi Square tests were used during statistical analysis.ResultsDuring the study period, 21 710 paediatric patients were included in the database with 129 (0.6%) sustaining traumatic cardiac arrest and meeting study inclusion criteria (1.3%). The majority had a pre-hospital traumatic cardiac arrest (103 (79.8%)). Overall, 62.8% were male, aged 11.7 years (3.4–16.6), ISS 34 (25–45) and 110 (85.3%) had blunt injuries with road-traffic collision the most common mechanism (56.6%). 123 (95.3%) had severe haemorrhage and/or traumatic brain injury.Table 1Table 2Table 3Overall survival was 5.4% (95% CI:2.6 to 10.8) with 7 cases surviving to 30 days. ‘Pre-hospital only’ traumatic cardiac arrest (13.0%) had a significantly higher survival than ‘pre-hospital and Emergency Department’ traumatic cardiac arrest (1.8%), (p=0.04). Those with injuries to the thorax predominated the severe haemorrhage group (67.6%). There were no survivors from ‘Emergency Department only’ traumatic cardiac arrest. Treatment at a major trauma centre was associated with a statistically significant increase in survival (p=0.02). There was no difference in survival between different times of day of presentation. Of those with Glasgow Outcome Scale recorded at discharge (n=6), four (66.7%) had either a moderate disability or good functional outcome.ConclusionAlthough a rare event, this study has demonstrated that resuscitation of children in traumatic cardiac arrest is not futile with overall outcomes comparable to survival rates seen in adults. Survival from pre-hospital traumatic cardiac arrest is possible and the early identification and aggressive management of these patients is advocated.

BackgroundTraumatic cardiac arrest (TCA) in children has traditionally been described as having a poor outcome. Survival rates vary widely between studies with higher rates observed from mechanisms leading to a respiratory cause of TCA (e.g. drowning and hanging). However, there is little evidence regarding outcomes following TCA in children. This study aims to describe the epidemiology and aetiology of paediatric TCA in England and Wales in an attempt to guide further research.MethodsThe Trauma Audit Research Network (TARN) database was interrogated to identify all children (<18 years) sustaining TCA between 2009 and 2015. For the purpose of this study, TCA was defined as a patient sustaining trauma, with agonal or absent respiration in the absence of a central pulse. Patients sustaining TCA following drowning, asphyxiation and electrocution were not included in the analysis. Patients with TCA both in the pre-hospital setting and in the emergency department (ED) and were included. The primary outcome was 30 day survival. Data on mechanism of injury, age, and injury severity were also analysed.ResultsDuring the study period, 65 patients met the inclusion criteria and sustained TCA, with the majority occurring in the pre-hospital setting (53.8%): 60% were male with a median age of 11 years (IQR 2.8–17.7 years) and a median ISS of 35 (IQR 26–75). Blunt injuries predominated (81.5%) with road traffic collision the most common mechanism (61.5%). Overall 30 day survival was 6.2% (n=4); all survivors were in the pre-hospital TCA subgroup.ConclusionAlthough a rare event, this study has demonstrated that resuscitation of children in TCA is not futile with overall outcomes comparable to survival rates seen in adults. Survival from pre-hospital TCA is possible and the early identification and aggressive management of these patients is advocated.

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