398 - Does Trauma Designation Matter? Post-Resuscitation Outcomes After Pediatric Non-Traumatic Cardiac Arrest

Publication Number: 4390.398

Laurel Bolton, Nemours Children's Hospital, Orlando, FL, United States; Mallory Volz, University of Central Florida College of Medicine, Orlando, FL, United States; Mina Ghali, University of Central Florida College of Medicine, Davie, FL, United States; Andrea Rivera-Sepulveda, Nemours Children's Health, Orlando, FL, United States

Background: Despite advances in pediatric resuscitation, survival and neurological outcomes after return of spontaneous circulation (ROSC) remain variable. While differences between in-hospital and out-of-hospital cardiac arrests are well described, the impact of emergency department (ED) trauma designation on post-ROSC stabilization and short-term outcomes is unknown. Trauma centers may offer greater access to critical care resources and coordinated team-based resuscitation, potentially improving outcomes for children with non-traumatic cardiac arrest.

Objective: To compare physiologic stabilization, seven-day survival, and neurological outcomes among pediatric patients achieving ROSC after non-traumatic cardiac arrest treated at trauma-designated versus non-trauma pediatric EDs.

Design/Methods: We conducted a retrospective cross-sectional study of patients ≤18 years with non-traumatic cardiac arrest who achieved ROSC in the prehospital or ED setting from January 2014-December 2023 across two free-standing children's hospitals: one trauma-designated and one non-trauma. Outcomes included seven-day survival and neurological status at discharge. Secondary outcomes assessed blood pressure, temperature, and glucose trends during the first 72 post-ROSC hours. Continuous and categorical variables were compared using Wilcoxon rank-sum and Fisher's exact tests (two-sided, p< 0.05).

Results: Sixty-three patients met inclusion criteria (trauma center n=45; non-trauma n=18). Median age was 3.1 years (range 0-18); 52% were male. Respiratory etiology accounted for 83% of arrests. Seven-day survival was not statistically different between trauma and non-trauma centers (55.6% vs 55.6%, p=1.00). Neurological outcomes at discharge were similar between cohorts, with 64% of patients at trauma centers and 50% at non-trauma centers showing no new deficits (p=0.66). Physiologic parameters were comparable between groups, except for higher glucose levels at 12-24 hours post-ROSC in the non-trauma cohort (181 mg/dL vs 132 mg/dL, p=0.009).

Conclusion(s): In this dual-center cohort of pediatric non-traumatic cardiac arrests with ROSC, trauma designation was not associated with differences in short-term survival or neurological recovery. Both trauma and non-trauma pediatric EDs achieved comparable post-resuscitation stabilization. These findings suggest that pediatric-focused resuscitation protocols and team readiness, rather than trauma designation alone, may drive early post-ROSC outcomes. Larger multicenter studies are warranted to explore whether trauma center resources confer long-term benefit in pediatric resuscitation.

Table 1. Summary of baseline variables between trauma vs non-trauma centers


Table 2. Summary of treament variables between trauma vs non-trauma centers
Abbreviations: PICU, pediatric intensive care unit

Figure 1. Outcome variables between trauma vs. non-trauma centers
Serial trends in systolic blood pressure, diastolic blood pressure, temperature, and glucose levels over the first 72 hours following ROSC for patients treated at trauma centers vs. non-trauma centers.
Abbreviations: ROSC, return of spontaneous circulation