Study objectives: To determine the survival and functional outcome of
pediatric blunt trauma victims demonstrating cardiovascular collapse,
including pulseless cardiopulmonary arrest or severe hypotension, on i
nitial presentation in an emergency department. Design: Seven-year con
secutive case-control series. Setting: Level I trauma center and unive
rsity teaching hospital. Participants: Two thousand one hundred twenty
consecutive pediatric victims of blunt trauma less than 16 years old
admitted to a Level I trauma center from August 1984 through December
1991 had a mortality of 5.2%. Thirty-eight patients (1.8%) demonstrate
d pulseless cardiac arrest or severe hypotension (systolic blood press
ure of 50 mm Hg or less) on initial presentation in the ED. Interventi
ons: All patients received basic and advanced life support consistent
with guidelines published by the American Heart Association, American
Academy of Pediatrics, and American College of Surgeons. Measurements
and main results: Survival, functional outcome, and donor status were
reviewed. Outcome of ED resuscitation (death or reanimation), post-ED
destination (morgue, operating room, or pediatric ICU) length of hospi
talization, functional outcome after hospital discharge, time to death
(time from admission to ED to declaration of death), cause of death,
total hospital costs, total hospital charges, and organ donation were
reviewed. There were no functional survivors among 38 pediatric victim
s of blunt trauma who presented to the ED in pulseless cardiac arrest
or with severe hypotension. Eleven of the 12 patients who were transfe
rred to the pediatric ICU died, the single survivor demonstrated profo
und neurologic impairment six years after hospitalization. Six of thes
e 12 patients were eligible potential donors and resulted in four mult
iorgan donors during the seven-year study. The mean hospital unreimbur
sed care for the 38 study patients was $3,514 per patient. Conclusion:
No child who presented with pulseless cardiac arrest or severe hypote
nsion following blunt trauma achieved functional survival. Reimbursed
care for pediatric victims of blunt trauma demonstrating cardiovascula
r collapse is disproportionately poor compared with that for pediatric
patients who maintain hemodynamic integrity in the ED. Half of all pa
tients who were stabilized sufficiently for transfer to the pediatric
ICU were eligible potential organ donors. Therefore aggressive resusci
tation of these patients may be justified if organ donation is serious
ly contemplated and aggressively pursued.