Significant factors in predicting sustained ROSC (return of spontaneous circulation) in paediatric patients with traumatic out-of-hospital cardiac arrest (OHCA) admitted to the emergency department. By intern 9001140 李凱靈. TitleAuthor(s): (Chang Hua Hosp.)
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Significant factors in predicting sustained ROSC (return of spontaneous circulation) in paediatric patients with traumatic out-of-hospital cardiac arrest (OHCA) admitted to the emergency department.
By intern 9001140
sustained ROSC was obtained in 20 OHCA patients, but only one (spleen laceration+massive internal bleeding) eventually discharged from hospital
-->percentage of sustained ROSC :35.7%
-->total mortality rate:98.2%Results(1)
Head and neck injury (majority in trauma group),
survival rate is very low , but 35.7% regained sustained ROSC
-->possible organ donation (sustained ROSC is necessary to prevent organ failure before surgical intervention)
-->thus, 2 survey (thorough head-to-toe)should be performed rapidly after 1 survey
-->X-ray , CT scan for accurate diagnosis without delay after brief neurologial examination
Initially cardiac rhythm:
success rate of initial CPR:
Survival rate of paediatric patients with cardiac arrest secondary to trauma is poor, especially in patients with head and thoracic injury.
1.Initial cardiac rhythm and the duration of in-hospital CPR were the most significant factors associated with sustained ROSC .
2.The success rate of initial CPR was higher in patients with PEA (P = 0.003) and VF (P = 0.03) than in patients with asystole
3.PEA and VF were better predictors of successful CPR outcome than asystole
-->accuracy and speed in reading the ECG and providing the appropriate management (for example, CPR in asystole or PEA; early defibrilation in VF or pulseless VT)
Survival analysis: OHCA children with trauma had a lower chance of survival than non-trauma children as the interval from the scene to the ER increased (P=0.008)
However, clinically, some patients in the study received >25min of in-hospital CPR and regained sustained ROSC
Thus, in-hospital CPR may have to be performed for atleast 25 min to enable a spontaneous circulation to return