What are the guidelines on the withholding or terminating cardiopulmonary resuscitation (CPR) in pediatric out-of-hospital cardiac arrest?

Updated: Sep 15, 2020
  • Author: Catharine A Bon, MD; Chief Editor: Kirsten A Bechtel, MD  more...
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The American College of Surgeons, the American College of Emergency Physicians, the National Association of EMS Physicians, and the American Academy of Pediatrics have issued guidelines on the withholding or termination of resuscitation in pediatric out-of-hospital traumatic cardiopulmonary arrest. [29] Recommendations include the following:

  • Withholding resuscitation should be considered in cases of penetrating or blunt trauma victims who will obviously not survive.

  • Standard resuscitation should be initiated in arrested patients who have not experienced a traumatic injury.

  • Victims of lighting strike or drowning with significant hypothermia should be resuscitated.

  • Children who showed signs of life before traumatic CPR should be taken immediately to the emergency room; CPR should be performed, the airway should be managed, and intravenous or intraosseous lines should be placed en route.

  • In cases in which the trauma was not witnessed, it may be assumed that a longer period of hypoxia might have occurred and limiting CPR to 30 minutes or less may be considered.

  • When the circumstances or timing of the traumatic event are in doubt, resuscitation can be initiated and continued until arrival at the hospital.

  • Terminating resuscitation in children should be included in state protocols.

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