Epidemiology and aetiology of paediatric traumatic cardiac arrest in England and Wales

Abstract

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.

Association between out-of-hospital cardiac arrest and survival in paediatric traumatic population: results from the French national registry

“…In traumatic OHCA paediatric patients, the survival rate at Day 30 varied between 0 and 25.6%, with a pooled rate of 1.2%. We reported only a 2% Day 30 survival rate in our traumatic OHCA population, lower than previously reported in other countries (3.4% in Japan [23], 4.7% in England and Wales [24], and 5.4% in the USA and Canada [3,19]). The prehospital emergency systems are different between countries, which may explain this difference.…”

Comment upon “Time to epinephrine treatment is associated with the risk of mortality in children who achieve sustained ROSC after traumatic out-of-hospital cardiac arrest”

“…Fundamentally, we agree with the authors that “hemostasis, volume resuscitation and high-quality CPR” should be prioritised in major haemorrhage; however, we feel that the results of this study should be interpreted with caution and is unlikely to affect our current practice. This study, however, reaffirms the very poor prognosis associated with this catastrophic injury type [5].…”

Authors’ response to letter entitled ‘During a paediatric traumatic cardiac arrest, is ventricular fibrillation a reversible cause like any other?’

“…We have demonstrated that paediatric TCA is rare,2 and we respectfully suggest that VF within this cohort is an even rarer presenting rhythm.…”