Withholding or termination of resuscitation in pediatric out-of-hospital traumatic cardiopulmonary arrest

AMERICAN COLLEGE OF EMERGENCY PHYSICIANS, Pediatric Emergency Medicine Committee, Natalie E Lane

Research output: Contribution to journalReview articlepeer-review

22 Scopus citations

Abstract

This multiorganizational literature review was undertaken to provide an evidence base for determining whether recommendations for outof- hospital termination of resuscitation could be made for children who are victims of traumatic cardiopulmonary arrest. Although there is increasing acceptance of out-of-hospital termination of resuscitation for adult traumatic cardiopulmonary arrest when there is no expectation of a good outcome, children are routinely excluded from state termination-of-resuscitation protocols. The decision to withhold resuscitative efforts in a child under specific circumstances (decapitation or dependent lividity, rigor mortis, etc) is reasonable. If there is any doubt as to the circumstances or timing of the traumatic cardiopulmonary arrest, under the current status of limiting termination of resuscitation in the field to persons older than 18 years in most states, resuscitation should be initiated and continued until arrival to the appropriate facility. If the patient has arrested, resuscitation has already exceeded 30 minutes, and the nearest facility is more than 30 minutes away, involvement of parents and family of these children in the decision-making process with assistance and guidance from medical professionals should be considered as part of an emphasis on family-centered care because the evidence suggests that either death or a poor outcome is inevitable.

Original languageEnglish (US)
Pages (from-to)e1104-e1116
JournalPediatrics
Volume133
Issue number4
DOIs
StatePublished - Apr 2014

Keywords

  • Adolescent
  • Advanced life support
  • Basic life support
  • Blunt trauma
  • Cardiopulmonary resuscitation
  • Cardiorespiratory arrest
  • Children
  • Emergency medical services
  • Out-of-hospital termination of resuscitation
  • Out-ofhospital cardiac arrest
  • Outcome
  • Resuscitative thoracotomy
  • Survival
  • Traumatic cardiopulmonary arrest

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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