ABSTRACTS
EMS Transport of Pediatric Patients Meeting Termination of Resuscitation CriteriaAuthor: Casey Smith, AAS, NRP | | Associate Authors: William Cebulskie, MSMEd, NRP, Remle Crowe, PhD, NREMT, Danielle DiCesare, MD, Jeffrey Rollman, MPH, LP, Lynne Singleton, MS, PA-C, NRP, Lynn White, MS, FAEMS
Introduction Prehospital termination of resuscitation (TOR) protocols have demonstrated success in reducing futile transports for adult cardiac arrest patients, yet limited data exists evaluating transports of pediatric patients meeting TOR criteria. Objective To evaluate the rate of emergency medical services (EMS) transportation of pediatric patients in cardiac arrest who met pediatric termination of resuscitation (pTOR) criteria Methods For this retrospective analysis, we used the 2022 ESO Data Collaborative to identify 9-1-1 EMS responses for patients ages 0–17 years with cardiac arrest and attempted resuscitation by EMS. We excluded EMS-witnessed arrests and drownings. We applied the Maryland pTOR criteria for medical and traumatic arrests. Following previous research, we used scene time ≥ 30 minutes to approximate at least two 15-minute cycles of CPR for medical arrest criteria and scene time ≥ 10 minutes to approximate at least two 5-minute cycles of CPR for traumatic arrest criteria. Our primary outcome was EMS transportation. We summarized categorical variables using frequencies and percentages. Results We analyzed 1,278 pediatric cardiac arrests. Overall, 87% (n = 1,110) were transported, of which 27% (n = 299/1,110) had documented ROSC during the EMS encounter. Most arrests were medical (87%, n = 1,117) and 13% were traumatic (n = 161). pTOR criteria were met for 9% (n = 106/1,117) of medical arrests and 37% (n = 59/161) of traumatic arrests. Of those meeting pTOR criteria, 34% (n = 36/106) of medical arrests and 73% (n = 43/59) of traumatic arrests were transported. In patients transported without ROSC during the EMS encounter (n = 811), 9% (n = 64/708) of medical arrests met the 30-minute minimum scene time and 58% of trauma arrests (n = 60/103) met the 10-minute minimum scene time for termination eligibility. Conclusion One in three patients meeting medical pTOR criteria and nearly three out of four patients meeting traumatic pTOR criteria were transported by EMS. In medical arrests, most patients without ROSC were transported prior to meeting scene time for pTOR eligibility, suggestive of a “scoop and run” approach that may limit high-quality resuscitation. Limitations include retrospective review and inability to measure scene conditions preventing safe pTOR.
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