Survival and neurologic outcome after traumatic out-of-hospital cardiopulmonary arrest in a pediatric and adult population: a systematic review
Critical Care, 2012 Volume 16 Issue 4
This systematic review is focused on the in-hospital mortality and neurological outcome of survivors after prehospital resuscitation following trauma. Data were analysed for adults/pediatric patients and for blunt/penetrating trauma.
A systematic review was performed using the data available in Ovid Medline. 476 articles from 1/1964 – 5/2011 were identified by two independent investigators and 47 studies fulfilled the requirements (admission to hospital after prehospital resuscitation following trauma). Neurological outcome was evaluated using the Glasgow outcome scale.
34 studies/5391 patients with a potentially mixed population (no information was found in most studies if and how many children were included) and 13 paediatric studies/1243 children (age ≤ 18 years) were investigated. The overall mortality was 92.8% (mixed population: 238 survivors, lethality 96.7%; paediatric group: 237 survivors, lethality 86.4% = p < 0.001).
Penetrating trauma was found in 19 studies/1891 patients in the mixed population (69 survivors, lethality: 96.4%) and in 3 pediatric studies/91 children (2 survivors lethality 97.8%).
44.3% of the survivors in the mixed population and 38.3% in the group of children had a good neurological recovery. A moderate disability could be evaluated in 13.1% in the mixed population and in 12.8% in children. A severe disability was found in 29.5% of the survivors in the mixed patients and in 38.3% in the group of children. A persistent vegetative state was the neurological status in 9.8% in the mixed population and in 10.6% in children.
For each year prior to 2010, the estimated log-odds for survival decreased by 0.022 (95%-CI: [0.038;0.006]). When jointly analysing the studies on adults and children, the proportion of survivors for children is estimated to be 17.8% (95%-CI: [15.1%;20.8%]). According to the authors, the difference of the paediatric compared to the adult proportion is significant (p < 0.001).
The authors found that children have a higher chance of survival after resuscitation of an out-of-hospital traumatic cardiac arrest compared to adults but tend to have a poorer neurological outcome at discharge. According to the authors, the key messages are:
• Children have a higher chance of survival after resuscitation of an OHCA compared to adults, but tend to have a poorer neurological outcome on discharge from hospital.
• Long-term survival is significantly different with 3.3% in a mixed adult/child population and 13.6% in a paediatric population.
• Survival after blunt trauma is significantly higher in the paediatric group.
• Long-term survival is good and moderate neurological recovery is reported in 57.4% of all survivors in a mixed adult/child population and in 51.1% of a paediatric population.
• Starting CPR in trauma patients may be worthwhile and trauma management programs should be discussed critically.
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