When to stop: Termination of Resuscitation in Pediatric Traumatic Cardiac Arrest

Field termination of pediatric resuscitation is a difficult topic for EMS systems, prehospital providers, first responders, and the patient’s family. Clear guidelines exist for the termination of resuscitation of adults in cardiac arrest for both traumatic and non-traumatic etiologies, and routine transportation of adults in cardiac arrest all but guarantees poor outcomes. Unfortunately, for pediatric patients no clear guidelines exist to help drive the decision, so practically all pediatric patients suffering from traumatic cardiac arrest receive on-going resuscitation during transportation to hospital.  In this month’s Annals of Emergency Medicine, the American College of Surgeons, American College of Emergency Physicians, National Association of EMS Physicians, and American Academy of Pediatrics released a joint statement providing general guidelines for withholding or terminating resuscitative efforts in out-of-hospital pediatric traumatic cardiac arrest [1]. This paper undertook a review of all available literature on the topic in an attempt to form evidence based guidelines. In total, 27 articles were identified which were relevant to the topic and contained data applicable to the guideline being developed. No Class I evidence was found, which is unsurprising as it is difficult to perform large randomized controlled trials on adult OOHCA, let alone pediatric OOHCA. These 27 papers contained outcome data on 1114 patients, with only 60 survivors (5.4%). Of t...
Source: EMS 12-Lead - Category: Cardiology Authors: Tags: ems-topics patient-management pediatrics cardiac arrest Christopher Watford Do Not Resuscitate Paramedic resuscitation special resuscitation situations Source Type: research