Survival rates in the absence of signs of life following blunt trauma, as many have previously noted, are dismal – to be measured in the fractions of a percent. As such, few advocate the use of the resuscitative thoracotomy, particularly outside centers with such surgical expertise as to definitively manage underlying injury.
But, children tend to exhibit remarkable healing powers compared to adults – are their outcomes any better?
Barely.
This National Trauma Data Bank review identified 3,115,597 individuals less than 18 years of age treated for blunt trauma. Of these, 7,766 had no signs of life upon initial evaluation. One quarter of these successfully regained signs of life prior to Emergency Department arrival – and ultimately 13.8% survived to discharge. The remainder had no signs of life on Emergency Department arrival, and only 1.5% survived. 499 ED thoracotomies were performed – and survival was 1.3% in this cohort.
The authors of this study are very clearly negative in their assessment of the value of ED thoracotomy in this population. It is a reasonable stance, given the apparent low yield of intervention in such a population. While it is imprudent to use the word “never” – depending on the resource utilization, costs, and risks associated with an individual resuscitation, unfortunately, it rather seems aggressive measures ought be undertaken only in exceptional circumstances.
“Survival of pediatric blunt trauma patients presenting with no signs of life in the field”
http://www.ncbi.nlm.nih.gov/pubmed/25159245