Duration of Resuscitation and Survival of Pediatric Traumatic Cardiac Arrest

Objectives: To evaluate the association between resuscitation duration and survival from pediatric traumatic cardiac arrest (TCA). Methods: A meta-analysis was conducted. CENTRAL, MEDLINE, and EMBASE were searched from January 1, 2000, to January 31, 2026. Eligible studies included English-language original research involving children (<18 y) undergoing resuscitation for TCA. Results: Thirteen studies were included, comprising 28 survivors, 21 survivors with favorable outcomes, and 281 nonsurvivors or patients with unfavorable outcomes. The pooled mean resuscitation duration was 5.9 (95% CI: 2.5-9.2) minutes among survivors, 7.7 (95% CI: 0.1-17.7) minutes among survivors with favorable outcomes, and 44.8 (95% CI: 33.0-56.6) minutes among nonsurvivors or those with unfavorable outcomes. Resuscitation duration was significantly shorter in survivors than nonsurvivors ( P =0.0002) and in patients with favorable versus unfavorable outcomes ( P =0.0293). Individual patient data showed that 50% of survivors achieved return of spontaneous circulation (ROSC) within 13 minutes, 77.8% within 23 minutes, 88.9% within 30 minutes, and all survivors within 45 minutes. Among survivors with favorable outcomes, 87.5% achieved ROSC within 30 minutes, and all within 45 minutes. Conclusions: Evidence regarding the association between resuscitation duration and survival after pediatric TCA remains highly limited. Available data suggest that survivors of predominantly blunt pediatric TCA generally achieve ROSC early during resuscitation, with pooled mean resuscitation durations of ~6 minutes in all survivors and 8 minutes in survivors with favorable outcome. Resuscitation efforts in nonsurvivors are continued for a pooled mean duration of ~45 minutes. No survivor was identified after resuscitation >45 minutes.