Does Trauma Designation Matter? Post-Return of Spontaneous Circulation Outcomes After Pediatric Nontraumatic Cardiac Arrest

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 resuscitation, potentially improving outcomes for children with non-traumatic cardiac arrest. This study compared 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.

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 between January 2014 and December 2023 across two freestanding children’s hospitals: one trauma designated and one non-trauma. Primary outcomes were seven-day survival and neurological status at discharge. Secondary outcomes included trends in blood pressure, temperature, and glucose during the first 72 hours post-ROSC. Statistical comparisons utilized Wilcoxon rank-sum and Fisher’s exact tests (two-sided, p< 0.05).

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

In this dual-center cohort of pediatric non-traumatic cardiac arrests with ROSC, trauma designation was not associated with differences in early survival or neurological recovery. Both center types achieved similar post-resuscitation stabilization, suggesting that resuscitation protocols and team readiness may influence outcomes more than trauma designation alone. Larger multicenter studies are needed to assess potential long-term differences.