Paediatrics: Following unsuccessful resuscitation

Following unsuccessful resuscitation

The death of a child is distressing. The family should be spoken to sympa-thetically and in private. Most parents will want to see and hold their dead child and they should be offered this opportunity.

Report to the coroner (UK)

·  Unexpected deaths (see b Sudden unexpected death in an infant (SUDI)).

·  Infants brought in dead to the emergency department or who die soon after arrival.

·  Deaths where there has been recent surgery or an accident.

·  Deaths where there are suspicious circumstances.

Sudden unexpected death in an infant (SUDI)

Parents or carers

·  Take and record a detailed clinical history.

·  Explain that a referral has been made to the coroner. Explain the role of the police and warn the family that they may visit the house.

Child

After failed resuscitation the endotracheal tube and IO needle can be removed, but venous access should be retained. Retain the child’s cloth-ing/bedding and nappy for the police. Take the following samples:

·  Nasopharyngeal aspirate: virology and bacteriology.

·  Urine: biochemistry and freeze immediately.

·  Blood: toxicology, cultures, metabolic and coagulation screen.

·  Lumbar puncture (cerebrospinal fluid (CSF) for virology and culture): if indicated.

Other professionals

Inform the following:

·  Senior clinical staff: in the UK a designated SUDI team will investigate these deaths and a home visit will be made by the paediatrician and police within 24hr.

·  Family general practitioner.

·  Health visitor (or community midwife).

·  Neonatologist (if a neonate).

Follow-up

·  Arrangements should be made for the family to discuss the results of the coroner’s post-mortem.

·  Genetic counselling may be needed.

·  Bereavement counselling should be offered: this may be provided by the family practitioner, the paediatric team, or from other agencies (e.g. Foundation for the Study of Infant Deaths, Child Death Helpline, and CRUSE).