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Paediatric traumatic cardiac arrest: the development of an algorithm to guide recognition, management and decisions to terminate resuscitation
  1. James Vassallo1,2,
  2. Tim Nutbeam1,3,
  3. Annette C Rickard1,
  4. Mark D Lyttle4,5,
  5. Barney Scholefield6,
  6. Ian K Maconochie7,8,
  7. Jason E Smith1,2
  8. on behalf of PERUKI (Paediatric Emergency Research in the UK and Ireland)
  1. 1Emergency Department, Derriford Hospital, Plymouth, UK
  2. 2Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Academia), Birmingham, UK
  3. 3University of Plymouth, Plymouth, UK
  4. 4Emergency Department, Bristol Royal Children’s Hospital, Bristol, UK
  5. 5Faculty of Health and Applied Sciences, University of West England, Bristol, UK
  6. 6Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
  7. 7Emergency Department, St Marys Hospital, London, UK
  8. 8Trauma Audit and Research Network, University of Manchester, Manchester, UK
  1. Correspondence to Dr James Vassallo, Emergency Department, Derriford Hospital, Plymouth, PL6 8DH, UK; vassallo{at}doctors.org.uk

Abstract

Introduction Paediatric traumatic cardiac arrest (TCA) is a high acuity, low frequency event. Traditionally, survival from TCA has been reported as low, with some believing resuscitation is futile. Within the adult population, there is growing evidence to suggest that with early and aggressive correction of reversible causes, survival from TCA may be comparable with that seen from medical out-of-hospital cardiac arrests. Key to this survival has been the adoption of a standardised approach to resuscitation. The aim of this study was, by a process of consensus, to develop an algorithm for the management of paediatric TCA for adoption in the UK.

Methods A modified consensus development meeting of UK experts involved in the management of paediatric TCA was held. Statements discussed at the meeting were drawn from those that did not reach consensus (positive/negative) from a linked three-round online Delphi study. 19 statements relating to the diagnosis, management and futility of paediatric TCA were initially discussed in small groups before each participant anonymously recorded their agreement with the statement using ‘yes’, ‘no’ or ‘don’t know’. In keeping with our Delphi study, consensus was set a priori at 70%. Statements reaching consensus were included in the proposed algorithm.

Results 41 participants attended the meeting. Of the 19 statements discussed, 13 reached positive consensus and were included in the algorithm. A single statement regarding initial rescue breaths reached negative consensus and was excluded. Consensus was not reached for five statements, including the use of vasopressors and thoracotomy for haemorrhage control in blunt trauma.

Conclusion 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.

  • paediatric resuscitation
  • paediatric emergency med
  • paediatric injury
  • major trauma management
  • cardiac arrest

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Footnotes

  • Twitter @jamievassallo

  • Contributors The authors JV, TN, ACR, MDL and JES conceived, designed and conducted the study and were responsible for the acquisition of data. JV and TN analysed and interpreted the data and drafted the first manuscript. All remaining authors, ACR, MDL, JES, BS and IKM were responsible for revising it critically for important intellectual content. JV conducted the revisions to the manuscript, with MDL and JES critically reviewing it for important intellectual content. All authors reviewed the final second manuscript prior to resubmission. JV takes responsibility for the manuscript as guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests Two of the authors (JV and JES) are serving members of the UK Royal Navy.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Presented at This work was presented as an oral presentation at the Royal College of Emergency Medicine Annual Scientific Conference in September 2017 by JV.

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