Original Article

CME Article: Assessment of the Need for Immediate Trauma Team Presence for Infants Presenting in Cardiac Arrest

Authors: Emily C. Alberto, MD, Lauren J. Waterhouse, BS, Jennifer L. Fritzeen, MSN, RN, Constance R. DiAngelo, MD, Victoria H. Scheidt, , Randall S. Burd, MD, PhD


Objectives: Out-of-hospital cardiac arrest (OHCA) is rare in infants, with the cause of arrest often unknown upon presentation. Nonaccidental trauma is a potential etiology of OHCA among infants, but its occult presentation makes this etiology challenging to diagnose. In the absence of apparent injuries, identifying the need for trauma team activation is difficult during the initial resuscitation of infants with OHCA.

Methods: We performed a retrospective chart review of infants younger than 1 year old who presented to Children’s National Health System from 2012 to 2016 with cardiopulmonary resuscitation in progress. Medical records and the trauma registry were reviewed for relevant resuscitation information. Autopsy records provided the cause and manner of death, contributing factors to death, and evidence of injury.

Results: Among 592 infants undergoing resuscitation during the study period, 34 infants (5.7%) presented in cardiac arrest. The average age on presentation was 101.2 days (standard deviation 78.7). Most of the patients (n = 32, 94.1%) died in the emergency department, with none surviving to discharge. Among the 32 infants for whom autopsy records were available, the cause of death was nonaccidental trauma in one patient (3.1%).

Conclusions: Infant OHCA had poor outcomes, with trauma as a rare etiology. In the absence of external signs of injury or known injury mechanism, immediate trauma team presence was not beneficial for these infants during the initial resuscitation phase.
Posted in: Emergency & Disaster Medicine14

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1. Centers for Disease Control. 10 leading causes of death by age group, United States-2016. https://www.cdc.gov/injury/images/lc-charts/leading_causes_of_death_age_group_2016_1056w814h.gif. Accessed December 17, 2018.
3. Fink EL, Prince DK, Kaltman JR, et al. Unchanged pediatric-out-of-hospital cardiac arrest incidence and survival rates with regional variation in North America. Resuscitation 2016;107:121-128.
4. Atkins DL, Everson-Stewart S, Sears GK, et al. Epidemiology and outcomes from out-of-hospital cardiac arrest in children: the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest. Circulation 2009;119:1484-1491.
5. Jayaram N, McNally B, Tang F, et al. Survival after out-of-hospital cardiac arrest in children. J Am Heart Assoc 2015;4:ee002122.
6. Crewdson K, Lockey D, Davies G. Outcome from paediatric cardiac arrest associated with trauma. Resuscitation 2007;75:29-34.
7. Donoghue AJ, Nadkarni V, Berg RA, et al. Out-of-hospital pediatric cardiac arrest: an epidemiologic review and assessment of current knowledge. Ann Emerg Med 2005;46:512-522.
8. Ong ME, Stiell I, Osmond MH, et al. Etiology of pediatric out-of-hospital cardiac arrest by coroner’s diagnosis. Resuscitation 2006;68:335-342.
9. Engdahl J, Axelsson A, Bång A, et al. The epidemiology of cardiac arrest in children and young adults. Resuscitation 2003;58:131-138.
10. Hasselqvist-Ax I, Riva G, Herlitz J, et al. Early cardiopulmonary resuscitation in out-of-hospital cardiac arrest. N Engl J Med 2015;372:2307-2315.
11. Hymel KP, Committee on Child Abuse and Neglect. Distinguishing sudden infant death syndrome from child abuse fatalities. Pediatrics 2006;118:421-427.
12. Goto Y, Funada A, Goto Y. Duration of prehospital cardiopulmonary resuscitation and favorable neurological outcomes for pediatric out-of-hospital cardiac arrests: a nationwide, population-based cohort study. Circulation 2016;134:2046-2059.
13. Centers for Disease Control and Prevention. Sudden unexpected infant death and sudden infant death syndrome: about SUID and SIDS. https://www.cdc.gov/sids/about/index.htm. Accessed February 12, 2019.
14. Lambert ABE, Parks SE, Shapiro-Mendoza CK. National and state trends in sudden unexpected infant death: 1990-2015. Pediatrics 2018;141:e20173519.
15. Betchel K. Sudden unexpected infant death differentiating natural from abusive causes in the emergency department. Pediatr Emerg Care 2012;28:1085-1091.
16. National Institutes of Health. Safe to sleep: explore the campaign. https://safetosleep.nichd.nih.gov/activities/campaign. Accessed December 18, 2018.
17. Parker K, Pitetti R. Mortality and child abuse in children presenting with apparent life-threatening events. Pediatr Emerg Care 2011;27:591-595.
18. Altman RL, Brand DA, Forman S, et al. Abusive head injury as a cause of apparent life-threatening events in infancy. Arch Pediatr Adolesc Med 2003;157:1011-1015.