Bystander CPR and Survival After Pediatric Cardiac Arrest

Study Questions:

What are the characteristics and outcomes of bystander cardiopulmonary resuscitation (CPR) and compression-only CPR following pediatric out-of-hospital cardiac arrest (OHCA)?

Methods:

This was a secondary data analysis of the Cardiac Arrest Registry to Enhance Survival (CARES) database for entries from 2013 through 2015.

Results:

There were 3,900 children younger than 18 years with OHCA; 59% were infants, 60% were female, and 92% had nonshockable rhythms. Bystander CPR was performed on 47% of children and was more common for white children (56%) compared with African American (39%) or Hispanic children (43%) (p < 0.001). Overall survival and neurologically favorable survival were 11% and 9%, respectively. Bystander CPR was independently associated with improved overall survival and neurologically favorable survival compared with no bystander CPR. Conventional CPR was associated with better outcomes than chest compression only CRP. Among infants, conventional bystander CPR was associated with improved overall survival and neurologically favorable survival, while compression-only CPR had similar outcomes to no bystander CPR.

Conclusions:

Bystander CPR is associated with improved outcomes in pediatric OHCAs. There should be a focus on improving the frequency of bystander CPR in minority communities. Increasing the use of conventional bystander CPR may improve outcomes for children with OHCA.

Perspective:

Most pediatric OHCAs are probably related to sudden infant death syndrome. While survival rate after an OHCA in children in the present report is still abysmally low, it is higher than previously reported. This improvement is probably related to a higher application of bystander CPR (47% in the present study), and perhaps improved post-cardiac arrest care. Poor outcomes despite a relatively high bystander CPR rate may in part reflect the fact that most arrests are not witnessed. A large body of evidence corroborates bystander CPR in all settings, and suggests that CPR with rescue breaths is better than compression-only CPR, but that compression-only CPR is still of some benefit. The one exception is infants, in whom all studies, including the present report, support conventional CPR (chest compressions and breaths). Health agencies should improve public awareness and engagement. New national initiatives to broaden the reach of CPR training would be beneficial, as would innovative approaches involving smart phone and other technologies to speed up and focus bystander response. Time is of the essence.


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