Experts have produced the first consensus-based algorithm specific on the management of paediatric traumatic cardiac arrest (TCA) for adoption in the United Kingdom.
The tool, developed by the group Paediatric Emergency Research in the UK and Ireland (PERUKI), sets out a checklist of lifesaving interventions that should be prioritised over chest compressions and defibrillation in children presenting with TCA:
- External haemorrhage control;
- Adequate oxygenation and ventilation;
- Bilateral thoracostomies;
- Rapid volume replacement with warmed blood and blood products;
- Pelvic binder in blunt trauma.
Where there is return of spontaneous circulation (ROSC), vasopressors can be considered in isolated head injury. The decision to cease resuscitation should be guided by the duration of cardiac arrest, persistently low end-tidal carbon dioxide and cardiac standstill on ultrasound.
PERUKI experts failed to reach either a positive or negative consensus on the use of vasopressors (either by bolus or infusion) before return of ROSC in the context of any paediatric TCA, including paediatric TCA from suspected isolated traumatic brain injury.
The group also failed to reach consensus for or against thoracotomy in blunt paediatric TCA. Thoracotomy is therefore presented as an option for consideration, but without clear recommendation, within the algorithm.
The new algorithm is not intended for the management of cardiac arrest following asphyxia or suffocation, drowning and electrocution.