This multiorganizational literature review was undertaken to provide an evidence base for determining whether recommendations for out-of-hospital termination of
resuscitation could be made for children who are victims of traumatic
cardiopulmonary arrest. Although there is increasing acceptance of out-of-hospital termination of
resuscitation for adult traumatic
cardiopulmonary arrest when there is no expectation of a good outcome, children are routinely excluded from state termination-of-
resuscitation protocols. The decision to withhold resuscitative efforts in a child under specific circumstances (
decapitation or dependent lividity,
rigor mortis, etc) is reasonable. If there is any doubt as to the circumstances or timing of the traumatic
cardiopulmonary arrest, under the current status of limiting termination of
resuscitation in the field to persons older than 18 years in most states,
resuscitation should be initiated and continued until arrival to the appropriate facility. If the patient has arrested,
resuscitation has already exceeded 30 minutes, and the nearest facility is more than 30 minutes away, involvement of parents and family of these children in the decision-making process with assistance and guidance from medical professionals should be considered as part of an emphasis on family-centered care because the evidence suggests that either death or a poor outcome is inevitable.