Cardiopulmonary resuscitation in pediatric trauma patients: Survival and functional outcome

Background: Although injury is the leading cause of cardiac arrests in chil dren older than 1 year, few studies have examined the survival and function al outcome of cardiopulmonary resuscitation (CPR) in pediatric trauma patie nts. Methods: A historical cohort of 957 trauma patients younger than 15 years w ho received CPR at the scene of injury or at the admitting hospital was con structed on the basis of the National Pediatric Trauma Registry. The rate o f survival to discharge and factors related to survival were examined. Func tional impairments were documented for surviving patients. Results: The overall survival rate was 23.5%, With adjustment for the Injur y Severity Score, the risk of fatality after CPR increased for children wit h systolic blood pressure below 60 mm Hg at admission (odds ratio [OR] 24.5 , 95% confidence interval [CI] 8.6-69.3), for those who were comatose at ad mission (OR, 4.7; 95% CI, 1.9-11.6), for those with penetrating injury (OR, 4.4; 95% CI, 1.5-13.3), and for those with CPR initiated at the hospital ( OR, 2.4; 95% CI, 1.5-3.9), Surviving patients stayed in hospitals for an av erage of 24.3 days; at discharge, 64% had at least one impairment in the fu nctional activities of daily living. Conclusions: Survival outcome of CPR in pediatric trauma patients appears t o be comparable to that reported in adults of mixed arrest causes. Future r esearch needs to identify factors underlying the excess mortality associate d with penetrating trauma.