Do resuscitation attempts in children who die, cause injury?

Objective: To determine the incidence, type, and pattern of injury related to resuscitation attempts in children who die. Design: Retrospective review of ambulance, hospital, and necropsy case records. Method: All children who died aged 0-14 years between 1994 and 1996, and underwent a full necropsy at the Victorian Institute of Forensic Medicine (Melbourne, Australia) were identified. Children who were subject to recognised trauma before resuscitation or died because of a congenital abnormality were excluded. The records of all remaining children were reviewed. Children were grouped according to whether resuscitation was attempted or not. Results: From a total of 346 children who died, 204 (58.6%) were identified as meeting the inclusion criteria. Resuscitation was performed in 153 (75%) children and was started before ambulance arrival in 123 (60.3%) children. Injuries were detected at necropsy in 65 (42.5%) of children who had resuscitation compared with six (11.7%) of children who had no resuscitation (p<0.0001) chi(2) test. All but two of these injuries were of a minor nature consisting principally of bruises or abrasions. Two significant injuries were identified both occurring as a result of readily identifiable resuscitation procedures. The likelihood of injury increased with the length of resuscitation. In children resuscitated for less than 60 minutes the incidence of injury was 27% compared with 62% for children resuscitated for longer (P<0.0001). Conclusion: This study has shown that cardiopulmonary resuscitation commonly causes minor injuries such as superficial bruises and abrasions and the likelihood of such injury increases with the duration of the cardiopulmonary resuscitation. This information should reassure parents and caregivers that basic life support may be instituted without fear of causing significant injury or adversely affecting outcome in the child with cardiorespirotary arrest. Caution must be exercised when attributing significant injuries to resuscitation attempts and alternative causes must be fully investigated.