Daniel J. Pallin, MD, MPH reviewing Naim MY et al. JAMA Pediatr 2016 Nov 12.
Survival rates were almost 4% higher in children who received bystander cardiopulmonary resuscitation than in those who did not.
Cardiac arrest in children most commonly has a respiratory etiology, versus a cardiac etiology in adults. Some studies suggest that bystander cardiopulmonary resuscitation (CPR) is effective in children (NEJM JW Emerg Med May 2012 and Crit Care Med 2012; 40:1410; NEJM JW Emerg Med Jun 2014 and J Am Heart Assoc 2014; 3:499) and that compression-only CPR is more effective than conventional CPR (compressions plus ventilations; NEJM JW Emerg Med Apr 2010 and Lancet 2010; 375:1347).
Investigators reviewed a U.S. database of out-of-hospital cardiac arrests from 2013 through 2015 to determine outcomes in children younger than 18 years.
Of 3900 children included in the database, more than half were infants (<1 year old). Bystander CPR was provided to only 46.5% of children and was more common among white than black or Hispanic children. After adjustment for likely confounders, rates of survival to hospital discharge were significantly higher in children who received bystander CPR than in those who did not (13.2% vs. 9.5%). The difference for neurologically intact survival was less pronounced (10.3% vs. 7.6%, respectively). Conventional CPR was associated with a higher rate of neurologically intact survival than compression-only CPR (12.9% vs. 9.6%); the rate with conventional CPR was significantly higher than that with no CPR, while the rate with compression-only CPR was not. Compression-only CPR conferred no benefit over no CPR in infants, whereas in older children, both CPR methods improved survival, but conventional CPR still appeared superior.
CITATION(S):
Naim MY et al. Association of bystander cardiopulmonary resuscitation with overall and neurologically favorable survival after pediatric out-of-hospital cardiac arrest in the United States: A report from the Cardiac Arrest Registry to Enhance Survival surveillance registry. JAMA Pediatr 2016 Nov 12; [e-pub].
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