Paediatric traumatic cardiac arrest: A Delphi study to establish consensus on definition and management

Rickard, Annette C; Vassallo, James; Nutbeam, Tim; Lyttle, Mark; Maconochie, Ian K; Enki, Doyo G; Smith, Jason E

Abstract

Aims Paediatric traumatic cardiac arrest (TCA) is associated with low survival and poor outcomes. The mechanisms that underlie TCA are different from medical cardiac arrest; the approach to treatment of TCA may therefore also need to differ to optimise outcomes. The aim of this study was to explore the opinion of subject matter experts regarding the diagnosis and treatment of paediatric TCA, and to reach consensus on how best to manage this group of patients.

Methods An online Delphi study was conducted over three rounds, with the aim of achieving consensus (defined as 70% agreement) on statements related to the diagnosis and management of paediatric TCA. Participants were invited from paediatric and adult emergency medicine, paediatric anaesthetics, paediatric ICU and paediatric surgery, as well as Paediatric Major Trauma Centre leads and representatives from the Resuscitation Council UK. Statements were informed by literature reviews and were based on elements of APLS resuscitation algorithms as well as some concepts used in the management of adult TCA; they ranged from confirmation of cardiac arrest to the indications for thoracotomy.

Results 73 experts completed all three rounds between June and November 2016. Consensus was reached on 14 statements regarding the diagnosis and management of paediatric TCA; oxygenation and ventilatory support, along with rapid volume replacement with warmed blood, improve survival. The duration of cardiac arrest
and the lack of a response to intervention, along with cardiac standstill on ultrasound, help to guide the decision to terminate resuscitation.

Conclusion This study has given a consensus-based framework to guide protocol development in the management of paediatric TCA, though further work is required in other key areas including its acceptability to clinicians.

Citation

Rickard, A. C., Vassallo, J., Nutbeam, T., Lyttle, M., Maconochie, I. K., Enki, D. G., & Smith, J. E. (2018). Paediatric traumatic cardiac arrest: A Delphi study to establish consensus on definition and management. Emergency Medicine Journal, 35(7), 434-439. https://doi.org/10.1136/emermed-2017-207226

• Journal Article Type: Article
• Acceptance Date: Apr 17, 2018
• Online Publication Date: Apr 28, 2018
• Publication Date: Apr 30, 2018
• Journal: Emergency Medicine Journal
• Print ISSN: 1472-0205
• Electronic ISSN: 1472-0213
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 35
• Issue: 7
• Pages: 434-439
• DOI: https://doi.org/10.1136/emermed-2017-207226
• Public URL: https://uwe-repository.worktribe.com/output/868895
• Publisher URL: http://dx.doi.org/10.1136/emermed-2017-207226
• Additional Information: Additional Information : This is the author's accepted manuscript. The final published version is available here: http://dx.doi.org/10.1136/emermed-2017-207226