Trauma related paediatric cardiopulmonary arrest (TRPCPA) is associated with high mortality and children that do survive often suffer from life changing morbidity. The decision of when to stop Cardiopulmonary Resuscitation (CPR) is always difficult and is often at the clinician’s discretion.
The European Resuscitation Council Guidelines for Resuscitation 2015 provides guidance on the cessation of CPR. The majority of these criteria are clear and objective. However, criterion 4 asks clinicians to define futility at a time when they may have limited clinical information and in what is often a time critical and highly emotive environment allowing for variation in practice.
We aimed to review how objectively futility in TRPCPA is assessed and if it is defined well enough to aid clinician confidence in their decision making process.
We performed a systematic literature review of peer review articles published before January 2019. We identified articles that explored the futility or cessation of resuscitation in the context of TRPCPA.
We reviewed 13 relevant articles identified from Embase, Medline, Pubmed, Cochrane and Google Scholar.
There is little evidence available to support clinicians in defining futility in the context of TRPCPA. The evidence that is available is generally of poor quality with studies containing low numbers, differing inclusion criteria and variable survival and morbidity outcomes. The only emerging objective marker of futility suggested is the presence or absence of fixed pupils but this requires significantly more robust research before it is implemented clinically.