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Emerg Med J. 2018 Jul;35(7):434-439. doi: 10.1136/emermed-2017-207226. Epub 2018 Apr 28.

Paediatric traumatic cardiac arrest: a Delphi study to establish consensus on definition and management.

Author information

1
Emergency Department, University Hospitals Plymouth NHS Trust, Plymouth, UK.
2
Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research and Academia), Birmingham, UK.
3
Emergency Department, Bristol Royal Hospital for Children, Bristol, UK.
4
Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK.
5
Emergency Department, Imperial College NHS Healthcare Trust, London, UK.
6
Medical Statistics Group, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK.

Abstract

AIMS:

Paediatric traumatic cardiac arrest (TCA) is associated with low survival and poor outcomes. The mechanisms that underlie TCA are different from medical cardiac arrest; the approach to treatment of TCA may therefore also need to differ to optimise outcomes. The aim of this study was to explore the opinion of subject matter experts regarding the diagnosis and treatment of paediatric TCA, and to reach consensus on how best to manage this group of patients.

METHODS:

An online Delphi study was conducted over three rounds, with the aim of achieving consensus (defined as 70% agreement) on statements related to the diagnosis and management of paediatric TCA. Participants were invited from paediatric and adult emergency medicine, paediatric anaesthetics, paediatric ICU and paediatric surgery, as well as Paediatric Major Trauma Centre leads and representatives from the Resuscitation Council UK. Statements were informed by literature reviews and were based on elements of APLS resuscitation algorithms as well as some concepts used in the management of adult TCA; they ranged from confirmation of cardiac arrest to the indications for thoracotomy.

RESULTS:

73 experts completed all three rounds between June and November 2016. Consensus was reached on 14 statements regarding the diagnosis and management of paediatric TCA; oxygenation and ventilatory support, along with rapid volume replacement with warmed blood, improve survival. The duration of cardiac arrest and the lack of a response to intervention, along with cardiac standstill on ultrasound, help to guide the decision to terminate resuscitation.

CONCLUSION:

This study has given a consensus-based framework to guide protocol development in the management of paediatric TCA, though further work is required in other key areas including its acceptability to clinicians.

KEYWORDS:

cardiac arrest; paediatric resuscitation; resuscitation; trauma

PMID:
29705730
DOI:
10.1136/emermed-2017-207226
[Indexed for MEDLINE]

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