From the University of Pittsburgh Medical School.
Department of Emergency Medicine, University of Pittsburgh School of Medicine.
Pediatr Emerg Care. 2022 Sep 1;38(9):417-422. doi: 10.1097/PEC.0000000000002806. Epub 2022 Aug 6.
Children with traumatic arrests represent almost one third of annual pediatric out-of-hospital cardiac arrests (OHCAs). However, traumatic arrests are often excluded from study populations because survival posttraumatic arrest is thought to be negligible. We hypothesized that children treated and transported by emergency medical services (EMS) personnel after traumatic OHCA would have lower survival compared with children treated after medical OHCA.
We performed a secondary, observational study of children younger than 18 years treated and transported by 78 EMS agencies in southwestern Pennsylvania after OHCA from 2010 to 2014. Etiology was determined as trauma or medical by EMS services. We analyzed patient, cardiac arrest, and resuscitation characteristics and ascertained vital status using the National Death Index. We used multivariable logistic regression to test the association of etiology with mortality after covariate adjustment.
Forty eight of 209 children (23%) had traumatic OHCA. Children with trauma were older than those with medical OHCA (13.2 [3.8-15.9] vs 0.5 [0.2-2.4] years, P < 0.001). Prehospital return of spontaneous circulation frequency for trauma versus medical etiology was similar (90% vs 87%, P = 0.84). Patients with trauma had higher mortality (69% vs 45% P = 0.004).
More than 8 of 10 children with EMS treated and transported OHCA achieved return of spontaneous circulation. Despite lower survival rates than medical OHCA patients, almost one third of children with a traumatic etiology survived throughout the study period. Future research programs warrant inclusion of children with traumatic OHCA to improve outcomes.
外伤性心搏骤停患儿约占儿童院外心搏骤停（OHCA）年发生率的三分之一。然而，外伤性心搏骤停患者常被排除在研究人群之外，因为外伤性心搏骤停后患者的存活率被认为可忽略不计。我们假设，接受急救医疗服务（EMS）人员治疗和转运的外伤性 OHCA 患儿与接受医疗 OHCA 治疗的患儿相比，存活率较低。
我们对 2010 年至 2014 年期间宾夕法尼亚州西南部的 78 个 EMS 机构治疗和转运的 18 岁以下外伤性 OHCA 患儿进行了一项二次、观察性研究。病因通过 EMS 确定为创伤性或医源性。我们分析了患者、心搏骤停和复苏的特征，并通过国家死亡指数确定了生存状态。我们使用多变量逻辑回归来测试病因与调整协变量后死亡率之间的关联。
209 例患儿中 48 例（23%）有外伤性 OHCA。与医源性 OHCA 患儿相比，外伤性 OHCA 患儿年龄较大（13.2[3.8-15.9]岁 vs 0.5[0.2-2.4]岁，P<0.001）。创伤性与医源性病因的院前自主循环恢复频率相似（90% vs 87%，P=0.84）。创伤性病因患儿死亡率较高（69% vs 45%，P=0.004）。
接受 EMS 治疗和转运的 OHCA 患儿中，超过 80%的患儿实现了自主循环恢复。尽管与医源性 OHCA 患者相比，其生存率较低，但近三分之一的创伤性病因患儿在整个研究期间存活下来。未来的研究项目需要纳入外伤性 OHCA 患儿，以提高治疗效果。
