Significant factors in predicting sustained ROSC in paediatric patients with traumatic out-of-hospital cardiac arrest admitted to the emergency department.
BACKGROUND
Paediatric patients with out-of-hospital cardiac arrest (OHCA) due to trauma pose difficult challenges in resuscitation. Trauma is a major cause of OHCA in children. The aim of this study was to determine which factors were related to predicting a sustained return of spontaneous circulation (ROSC) in paediatric OHCA patients with trauma.


METHODS
This retrospective study comprised 115 paediatric patients (56 traumatic and 59 non-traumatic OHCA patients) aged younger than 18 years who had been admitted to the emergency department (ED) from January 2000 to December 2004. We analysed the demographic data and the factors that may have influenced sustained ROSC in the group of OHCA paediatric patients with trauma. The non-trauma group was established as a control group. Survival analysis was used to compare differences in survival rate between trauma and non-trauma OHCA patients. Receiver operating characteristic (ROC) analysis was used to determine the significant in-hospital CPR duration related to sustained ROSC.


RESULTS
Initial cardiac rhythm on arrival (P=0.005) and the duration of in-hospital CPR (P<0.001) were significant factors. Patients with PEA or VF had higher rate of sustained ROSC than those with asystole (PEA: P=0.003, VF: P=0.03). In the survival analysis, OHCA children with trauma had a lower chance of survival than non-trauma children as the interval from the scene to the ER increased (P=0.008). Based on the ROC analysis, the cut-off values of in-hospital CPR duration were 25min in OHCA paediatric patients with trauma.


CONCLUSIONS
Several significant factors relating to sustained ROSC were determined in the OHCA paediatric patients with trauma; most importantly, we found that in-hospital CPR may have to be performed for at least 25min to enable a spontaneous circulation to return.
Lin
Yan-Ren
YR
Department of Emergency Medicine, Changhua Christian Hospital, 135 Nanshsiao Street, Changhua 500, Taiwan.
Wu
Han-Ping
HP
Huang
Chin-Yi
CY
Chang
Yu-Jun
YJ
Lin
Ching-Yuang
CY
Chou
Chu-Chung
CC
D000293:Adolescent; D016887:Cardiopulmonary Resuscitation; D016009:Chi-Square Distribution; D002648:Child; D004636:Emergency Service, Hospital; D005260:Female; D006323:Heart Arrest / Q000209:etiology* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D010343:Patient Admission; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D016019:Survival Analysis; D014947:Wounds and Injuries / Q000150:complications* / Q000401:mortality