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Three Part Question

In [paediatric patients in (traumatic) cardiac arrest] does [resuscitation with blood] [improve survival]?

Clinical Scenario

A child suffers major trauma, resulting in cardiac arrest.

Search Strategy

Using OVID online world wide web interface. Medline (1946 – Sept week 2 2015) and Medline: In process & other non-indexed citations and Embase (1947 – 21/09/2015) using the OVID interface

Terms: (Initial strategy using MeSH headings turned up far fewer papers)
(cardi* or arrest* or "ventricular fibrillation" or VF or "ventricular tachy*" or VT or asystol* or pulseless or dea* or PEA).m_titl.
AND
(traum* or injuries or injured).m_titl.
AND
(paediatric or pediatric or child* or infant* or teenag* or adolescent*).m_titl.
Total number of papers = 450 (abstracts reviewed)
There were no specific papers concerned with fluid administration so the search strategy was widened to pick up any studies on adults that may have included children.
(cardi* or arrest* or "ventricular fibrillation" or VF or "ventricular tachy*" or VT or asystol* or pulseless or dea* or PEA).m_titl.
AND
(traum* or injuries or injured).m_titl.
AND
(fluid* or saline or hartmann* or ringers or crystalloid or colloid or dextran* or gelofusin or albumin or HAS or blood or transfus* or "red cell*" or platelet* or plasma or factor).mp. [mp=ti, ab, hw, tn, ot, dm, mf, dv, kw, nm, kf, px, rx, an, ui]
AND
(paediatric or pediatric or child* or infant* or teenag* or adolescent*).mp. [mp=ti, ab, hw, tn, ot, dm, mf, dv, kw, nm, kf, px, rx, an, ui]
Total number of papers = 65 (abstracts reviewed)
A third search was performed
(paediatric or pediatric or child* or infant* or teenag* or adolescent*).m_titl.
AND
Trauma*. m_titl.
AND
hypothermi* or cold* or cool*). m_titl.


2) Additional resources
Search term: paediatric/pediatric traumatic cardiac arrest
Cochrane Library Database
Best Bets Website
Pubmed
Google
MedlinePlus

Search Outcome

Total number of papers = 98 (titles reviewed)

No additional papers of relevance were identified though alternative searches.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Acker S, Partrick D, Ross J, Nadlonek N, Bronsert M, Bensard D 2014 USA	Paediatric trauma	retrospective review of the paediatric cases from a trauma database	Blood transfusion when not clearly indicated may result in worse clinical outcomes	Patients who received a transfusion had a higher ISS than those who did not (26.7 vs. 15.3). After controlling for age, sex, ISS, Glasgow Coma Scale (GCS) score on presentation, and mechanism of injury, patients who received a blood transfusion were more likely to be admitted to the intensive care unit (p < 0.0001), less likely to survive to hospital discharge (p = 0.02), more likely to be discharged to a rehabilitation facility (p = 0.01) and be dependent on caretakers at follow-up (p < 0.0001), as well as more likely to develop urinary tract infection (p = 0.02) and bacteremia (p = 0.02) during their hospital stay. These differences in outcomes among those who did and did not receive a blood transfusion began to disappear in patients with a nadir hemoglobin of less than 8.0 g/dL.	Paediatric traumatic cardiac arrest is not addressed directly.

Comment(s)

In this highly emotive subject, results are typically poor.

Clinical Bottom Line

There is no clear evidence to either support not reject blood transfusion in paediatric traumatic cardiac arrest. Where hypovolaemia is not considered to be the mechanism of arrest, transfusion might result in worse outcomes. Worldwide consensus and coordinated study is necessary to develop this field.

References

1. Acker S, Partrick D, Ross J, Nadlonek N, Bronsert M, Bensard D Blood component transfusion increases the risk of death in children with Journal of trauma and acute care surgery 76 (4) P1082 (2014)