10 Year Review of CPR Outcomes in Pediatric Trauma Jason Nielsen, - PowerPoint PPT Presentation

10 Year Review of CPR Outcomes in Pediatric Trauma Jason Nielsen, MD, Brian D. Kenney, MD, MPH, and Jonathan I. Groner, MD, FAAP ………………..……………………………………………………………………………………………………………………………………..

Disclosures • Neither I nor my colleagues have any disclosures. ………………..……………………………………………………………………………………………………………………………………..

CPR • Difficult subject • Especially when discussing termination of CPR • Also when children are involved • This difficulty is reflected in published guidelines ………………..……………………………………………………………………………………………………………………………………..

Background • Joint Position Statement of The National Association of EMS Physicians (NAEMSP) and the American College of Surgeons Committee on Trauma McSwain, Norman. Guidelines for the Termination of Resuscitation in Prehospital Traumatic Cardiopulmonary Arrest . JACS, March 2003, Vol196. Issue 3, p. 475-481 ………………..……………………………………………………………………………………………………………………………………..

Guidelines • “Termination of resuscitation efforts should be considered in trauma patients with EMS-witnessed cardiopulmonary arrest and 15 minutes of unsuccessful resuscitation and cardiopulmonary resuscitation (CPR).” ………………..……………………………………………………………………………………………………………………………………..

Guidelines Continued • “The recommendations contained within this paper do not extend to the pediatric population” • “..the vast majority of the patients were adults.” • “…additional studies may be warranted before including children in any protocol that allows for withholding or terminating resuscitation…” ………………..……………………………………………………………………………………………………………………………………..

Pediatric Guidelines • “The inclusion of children in state termination-of- resuscitation protocols should be considered, including children who are victims of blunt and penetrating trauma who have or in whom there is EMS-witnessed cardiopulmonary arrest and at least 30 minutes of unsuccessful resuscitative efforts, including CPR (Level 2).” Withholding or termination of resuscitation in pediatric out-of-hospital traumatic cardiopulmonary arrest. Pediatrics. 2014 Apr;133(4) ………………..……………………………………………………………………………………………………………………………………..

Objectives #1. Examine Pediatric CPR outcomes by trauma type. #2. Identify opportunities for improved resource utilization, patient/family education, and trauma patient management for patients presenting in arrest. ………………..……………………………………………………………………………………………………………………………………..

Methods 10 year retrospective review (20 yrs. in some cases) •All trauma admissions from 1/1/2003- 12/31/2013 at our large Pediatric Level 1 Trauma Center Inclusion Criteria: •All patients ≤ 18 ………………..……………………………………………………………………………………………………………………………………..

Patients Total Patients N=15,922 Level 1 Trauma 1,513 Level 2 Trauma 3,474 CPR 219 (1.38%) ………………..……………………………………………………………………………………………………………………………………..

Demographics Gender # % Male 141 64.4 Female 78 35.6 Race Caucasian 127 58.0 African American 66 30.1 Other 12 5.5 Unknown 14 6.4 4.5 ± 4.7 Average Age ………………..……………………………………………………………………………………………………………………………………..

Results Mortality # % Alive 28 12.8 Dead 191 87.2 Average ISS 29.1 ± 18.6 ………………..……………………………………………………………………………………………………………………………………..

Results by Mechanism Mechanism Total Male Average Average Mortality Patients Age ISS Hang 15 73.3% 87.0% 8.6 ± 6 15.5 ± 13.1 Drowning 46 61.0% 3.8 ± 2.9 25.4 ± 11.2 65.0% Asphyxiation 33 61.0% 94.0% 0.39 ± 0.40 22.7 ± 7.4 Burn 18 67.0% 4.7 ± 4.2 34.9 ± 20.6 100.0% Blunt 100 66.0% 92.0% 5.1 ± 4.9 32.6 ± 20.3 Penetrating 7 57.1% 10.3 ± 5.2 47.0 ± 26.8 100.0% ………………..……………………………………………………………………………………………………………………………………..

Mortality by Mechanism ………………..……………………………………………………………………………………………………………………………………..

Results Survivors Non-Survivors p Male 60.7% Male 64.9% 0.67 Age 4.4 ± 4.2 Age 4.5 ± 4.8 0.91 30.2 ± Avg. 24.1 ± Avg. 0.24 19.1 ISS 12.6 ISS ………………..……………………………………………………………………………………………………………………………………..

Blunt Trauma 1993-2003 11,563 Total 225 (1.9%) 5 Bradycardia Patients CPR 1 Seizure 1Tension 108 Blunt Pneumothorax 100 Died 1 Full Arrest 7 Survivors (92.6%) Survivor Not Full Arrest ………………..……………………………………………………………………………………………………………………………………..

Blunt Trauma 2003-2013 219 (1.4%) 15,922 Total CPR Patients 100 Blunt 92 Died 8 Survivors (92.0%) ………………..……………………………………………………………………………………………………………………………………..

Blunt Trauma Survivors • 3 patients had rapid recovery at the scene or in route • 1 Bradycardia • 2 Respiratory • 2 Short courses of CPR in ED (1-2 rounds of Epinephrine) ………………..……………………………………………………………………………………………………………………………………..

Conclusions • Few pediatric trauma patients benefit from CPR. • In the absence of a rapidly reversible cause, blunt trauma arrest patients have 100% mortality. ………………..……………………………………………………………………………………………………………………………………..

Conclusions • Given the poor outcomes of CPR in pediatric trauma patients the use of termination-of-resuscitation protocols are recommended ………………..……………………………………………………………………………………………………………………………………..

Questions ………………..……………………………………………………………………………………………………………………………………..