Paediatric Considerations

The low volume of paediatric traumatic out of hospital cardiac arrests (relative to adults) creates a challenging environment for maintaining skills and institutional preparedness. Traumatic cardiac arrest (TCA) in children is associated with a low probability of survival and poor neurological outcome in survivors.
In Australia, the mechanism of injury in children is usually due to blunt trauma with concealed haemorrhage, and the majority of this is made up from MVA’s with falls and non-accidental injury making up the rest. In blunt Paediatric TCA, the primary cause of death in a child is due to brain injury.
Paediatric traumatic cardiac arrest in penetrating trauma should follow the same principles as Adult TCA. The only difference should be towards the volume of fluid replacement (10ml/kg).
In children who have immediate CPR after TCA, then immediate transportation to the ED should be considered. Resuscitative manoeuvres such as airway management, CPR, intravenous or intraosseous line access should be performed in transit only if safe to do so for both patient and clinician.
Asystole in children following blunt trauma has a poor prognosis, so consideration for ceasing resuscitation efforts early should be given.
Signs of life in the prehospital or emergency department setting that favour a positive outcome with resuscitation efforts include pupillary response as well as organised cardiac activity on ultrasound, even if pulseless.
A child who has RT has only a minimal chance of survival.

Ambulance Victoria Cardiac Arrest - Trauma (Paediatric) Clinical Practice Guideline