Jon McCormack gives you what you need to know in the case of paediatric blunt traumatic cardiac arrest. This is a rare but deadly occurrence. Data shows that the population incidence for paediatric blunt traumatic arrest is 1 in 100 000. Of these, most are male, and most are involved in vehicle traffic accidents, along with falls and non-accidental injuries. The median age is 7 years old. The injuries are severe, and the survival numbers make for grim reading… around 1%. So, the numbers are low in both incidence and survival. However, the cases can be deeply personal and effect the clinician and bystanders for a long time. With that being the case, coupled with the enormous upside both socially and economically, surely emergency care should “go all in”. Jon explains why this is the wrong approach. He discusses the reality of the presentation of a paediatric blunt traumatic cardiac arrest. He advises to limit unnecessary treatments and risks to yourself and team. There are potential survivors. Children who maintain a detectable cardiac rhythm and show signs of life have better survival prognostics. Children in asystole or without signs of life will not survive. Objectively assessing signs of life may be important so Jon recommends being well versed in roadside echocardiograms. However, given the fact that the vast majority of children will be in excellent health at the time of injury, if they are showing no signs of life or cardiac activity, they have likely exhausted their enormous physiologic reserve. In this instance, they are in a decompensated which will lead to death. Finally, Jon concludes with some advice. In a paediatric blunt trauma cardiac arrest, initiate CPR and basic life support early, do not resort to a thoracotomy, and organise rapid triage and transport to a trauma centre if there are signs of life. If not, be prepared to stop futile treatments.
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