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Faulkner J, Carballo C, Colosimo C, Gratton A, Mentzer C, Yon J. Traumatic Cardiac Arrest in Pediatric Patients: An Analysis of the National Trauma Database 2007-2016. Am Surg 2022; 88:2252-2254. [PMID: 35848107 DOI: 10.1177/00031348221091937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to identify the population of pediatric patients who arrive without signs of life and describe outcomes using a national database.Patients eighteen and younger with no signs of life were pulled from the National Trauma Database (NTDB) from the years 2007-2016. A total of N = 7503 patients were separated into two cohorts for comparison. Subset analysis was also conducted for patients undergoing a thoracotomy. Statistical analysis was performed on the collected data. Over the 9-year period most patients died in the ED or hospital (95.7%), very few patients were discharged home (1.3%), and ED thoracotomies were performed rarely (9%) with most patients dying (97%).Arrival to the trauma bay without signs of life is associated with a dismal prognosis. Clinical judgment must be carefully applied to choose the small number of patients who would benefit from an aggressive approach.
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Affiliation(s)
- Justin Faulkner
- Department of General Surgery & Surgical Critical Care, 24520New Hanover Regional Medical Center, Wilmington, NC, USA
| | - Christopher Carballo
- Department of General Surgery & Surgical Critical Care, 24520New Hanover Regional Medical Center, Wilmington, NC, USA
| | | | - Austin Gratton
- Department of General Surgery & Surgical Critical Care, 24520New Hanover Regional Medical Center, Wilmington, NC, USA
| | - Caleb Mentzer
- Deparment of Trauma and Critical Care Surgery, 24520Spartanburg Regional Healthcare System, Spartanburg, SC, USA
| | - James Yon
- Department of General Surgery & Surgical Critical Care, 24520New Hanover Regional Medical Center, Wilmington, NC, USA
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Currie V, Tagg A, Kanaris C. What information can we use to help determine futility in paediatric patients presenting in traumatic cardiac arrest? Arch Dis Child 2022; 107:archdischild-2022-324138. [PMID: 35551048 DOI: 10.1136/archdischild-2022-324138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 04/22/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Victoria Currie
- Paediatrics, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Andrew Tagg
- Emergency, Western Hospital, Footscray, Melbourne, Australia
- School of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Constantinos Kanaris
- Paediatric Intensive Care, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Blizard Institute, Queen Mary University of London, London, UK
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Lee HM, Wang CT, Hsu CC, Chen KT. Algorithm to Improve Resuscitation Outcomes in Patients With Traumatic Out-of-Hospital Cardiac Arrest. Cureus 2022; 14:e23194. [PMID: 35444921 PMCID: PMC9010171 DOI: 10.7759/cureus.23194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 11/25/2022] Open
Abstract
Background: This study proposed an algorithm to improve resuscitation outcomes in the emergency department (ED) for patients with traumatic out-of-hospital cardiac arrest (TOHCA). We also performed a retrospective chart review of patient outcomes before and after implementing the algorithm and sought to define factors that might influence patient outcomes. Methods: In September 2018, we implemented an algorithm for patients with TOHCA. This algorithm rapidly identifies possible causes of TOHCA and recommends appropriate interventions. We retrospectively reviewed the outcomes of all patients with TOHCA during a five-year period (comprising periods before and after the algorithm) and compared the results before and after the implementation of the algorithm. Results: After this algorithm was implemented, the use of the ED interventions of blood transfusion, placement of a large-bore central venous catheter, and thoracostomy increased significantly. The rate of return of spontaneous circulation (ROSC) also increased (before vs. after: ROSC: 23.6% vs. 41.5%, P = 0.035). Regarding hospital admission and survival to hospital discharge, we observed the trend of increment (hospital admission: 18.2% vs. 24.6%, P = 0.394; survival to hospital discharge: 0.0% vs. 4.6%, P = 0.107). Admitted patients exhibited a higher end-tidal CO2 level during resuscitation than nonadmitted patients [admitted vs. nonadmitted: 41.5 (33.3-52.0) vs. 12.0 (7.5-18.8), P = 0.001]. Conclusion: Our algorithm prioritizes the three major treatable causes of TOHCA: impedance of venous return, hypovolemia, and hypoxia. We found that rate of ROSC increased with the increasing implementation of the ED interventions recommended by the algorithm.
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El Tawil C, LeBlanc PA, Beno S, Nemeth J. Traumatic cardiac arrest: unique considerations for the pediatric patient. CAN J EMERG MED 2022; 24:457-458. [PMID: 35191006 DOI: 10.1007/s43678-022-00283-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 02/08/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Chady El Tawil
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada.
| | - Pierre-Alexandre LeBlanc
- Division of Emergency Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Suzanne Beno
- Division of Emergency Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Joe Nemeth
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
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Leonhard G, Overhoff D, Wessel L, Viergutz T, Rudolph M, Schöler M, Haubenreisser H, Terboven T. Determining optimal needle size for decompression of tension pneumothorax in children - a CT-based study. Scand J Trauma Resusc Emerg Med 2019; 27:90. [PMID: 31604472 PMCID: PMC6788035 DOI: 10.1186/s13049-019-0671-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 09/25/2019] [Indexed: 12/22/2022] Open
Abstract
Background For neonates and children requiring decompression of tension pneumothorax, specific recommendations for the choice of needle type and size are missing. The aim of this retrospective study was to determine optimal length and diameter of needles for decompression of tension pneumothorax in paediatric patients. Methods Utilizing computed tomography, we determined optimal length and diameter of needles to enable successful decompression and at the same time minimize risk of injury to intrathoracic structures and the intercostal vessels and nerve. Preexisting computed tomography scans of the chest were reviewed in children aged 0, 5 and 10 years. Chest wall thickness and width of the intercostal space were measured at the 4th intercostal space at the anterior axillary line (AAL) on both sides of the thorax. In each age group, three needles different in bore and length were evaluated regarding sufficient length for decompression and risk of injury to intrathoracic organs and the intercostal vessels and nerve. Results 197 CT-scans were reviewed, of which 58 were excluded, resulting in a study population of 139 children and 278 measurements. Width of the intercostal space was small at 4th ICS AAL (0 years: 0.44 ± 0.13 cm; 5 years: 0.78 ± 0.22 cm; 10 years: 1.12 ± 0.36 cm). The ratio of decompression failure to risk of injury at 4th ICS AAL was most favourable for a 22G/2.5 cm catheter in infants (Decompression failure: right: 2%, left: 4%, Risk of injury: right: 14%, left: 24%), a 22G/2.5 cm or a 20G/3.2 cm catheter in 5-year-old children (20G/3.2 cm: Decompression failure: right: 2.1%, left: 0%, Risk of injury: right: 2.1%, left: 17%) and a 18G/4.5 cm needle in 10-year-old children (Decompression failure: right: 9.5%, left: 9.5%, Risk of injury: right: 7.1%, left: 11.9%). Conclusions In children aged 0, 5 and 10 years presenting with a tension pneumothorax, we recommend 22G/2.5 cm, 20G/3.2 cm and 18G/4.5 cm needles, respectively, for acute decompression.
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Affiliation(s)
- Georg Leonhard
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Daniel Overhoff
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Lucas Wessel
- Department of Paediatric Surgery, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Tim Viergutz
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Marcus Rudolph
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,DRF Stiftung Luftrettung gemeinnützige AG, Filderstadt, Germany
| | - Michael Schöler
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Holger Haubenreisser
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Tom Terboven
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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Terboven T, Leonhard G, Wessel L, Viergutz T, Rudolph M, Schöler M, Weis M, Haubenreisser H. Chest wall thickness and depth to vital structures in paediatric patients - implications for prehospital needle decompression of tension pneumothorax. Scand J Trauma Resusc Emerg Med 2019; 27:45. [PMID: 30992028 PMCID: PMC6469218 DOI: 10.1186/s13049-019-0623-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 03/26/2019] [Indexed: 11/20/2022] Open
Abstract
Background Recommendations regarding decompression of tension pneumothorax in small children are scarce and mainly transferred from the adult literature without existing evidence for the paediatric population. This CT-based study evaluates chest wall thickness, width of the intercostal space (ICS) and risk of injury to vital structures by needle decompression in children. Methods Chest wall thickness, width of the intercostal space and depth to vital structures were measured and evaluated at 2nd ICS midclavicular (MCL) line and 4th ICS anterior axillary line (AAL) on both sides of the thorax using computed tomography (CT) in 139 children in three different age groups (0, 5, 10 years). Results Width of the intercostal space was significantly smaller at the 4th ICS compared to the 2nd ICS in all age groups on both sides of the thorax. Chest wall thickness was marginally smaller at the 4th ICS compared to the 2nd ICS in infants and significantly smaller at 4th ICS in children aged 5 years and 10 years. Depth to vital structure for correct angle of needle entry was smaller at the 4th ICS in all age groups on both sides of the thorax. Incorrect angle of needle entry however is accompanied by a higher risk of injury at 2nd ICS. Furthermore, in some children aged 0 and 5 years, the heart or the thymus gland were found directly adjacent to the thoracic wall at 2nd ICS midclavicular line. Conclusion Especially in small children risk of iatrogenic injury to vital structures by needle decompression is considerably high. The 4th ICS AAL offers a smaller chest wall thickness, but the width of the ICS is smaller and the risk of injury to the intercostal vessels and nerve is greater. Deviations from correct angle of entry however are accompanied by higher risk of injury to intrathoracic structures at the 2nd ICS. Furthermore, we found the heart and the thymus gland to be directly adjacent to the thoracic wall at the 2nd ICS MCL in a few children. From our point of view this puncture site can therefore not be recommended for decompression in small children. We therefore recommend 4th ICS AAL as the primary site of choice. Electronic supplementary material The online version of this article (10.1186/s13049-019-0623-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tom Terboven
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Georg Leonhard
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Lucas Wessel
- Department of Paediatric Surgery, Mannheim University Medical Center, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Tim Viergutz
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Marcus Rudolph
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,DRF Stiftung Luftrettung gemeinnützige AG, Filderstadt, Germany
| | - Michael Schöler
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Meike Weis
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Holger Haubenreisser
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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Lemoine S, Jost D, Prunet B. During a paediatric traumatic cardiac arrest, is ventricular fibrillation a reversible cause like any other? Emerg Med J 2019; 36:191. [PMID: 30630839 DOI: 10.1136/emermed-2018-208290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Sabine Lemoine
- Paris Fire Brigade Medical Emergency Department, Paris, France
| | - Daniel Jost
- Paris Fire Brigade Medical Emergency Department, Paris, France.,Sudden Death Expertise Center (SDEC), INSERM U970, Paris, France
| | - Bertrand Prunet
- Paris Fire Brigade Medical Emergency Department, Paris, France
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Smith J, Vassallo J, Lyttle MD. Authors' response to letter entitled 'During a paediatric traumatic cardiac arrest, is ventricular fibrillation a reversible cause like any other?'. Emerg Med J 2019; 36:191. [PMID: 30630843 DOI: 10.1136/emermed-2018-208370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Jason Smith
- Emergency Department, Derriford Hospital, Plymouth, UK.,Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Academia), Birmingham, UK
| | | | - Mark D Lyttle
- Emergency Department, Bristol Royal Children's Hospital, Bristol, UK
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