Bystander CPR linked to improved outcomes for pediatric out-of-hospital cardiac arrest

1. In pediatric patients who experienced out-of-hospital cardiac arrest (OHCA), bystander-initiated cardiopulmonary resuscitation (BCPR) was linked to better survival and favorable neurologic outcomes.

2. Conventional CPR was associated with improved survival and neurologic outcomes compared to compression-only CPR (COR), with infants under 1 years of age experiencing no benefit from COR alone.

Evidence Rating Level: 2 (Good)       

Study Rundown: Mortality associated with out-of-hospital cardiopulmonary arrest is high. For adult out-of-hospital cardiac arrest (OHCA), there has been a change to promote compression-only CPR as opposed to conventional CPR with rescue breaths, since bystanders are often reluctant to perform rescue breaths. While this change has not worsened outcomes in adults, the same may not be true in the pediatric population since most of those arrests are caused by asphyxiation, wherein conventional CPR with rescue breaths is likely more efficacious. This study sought to evaluate the prevalence and benefit of bystander CPR and compare efficacy of conventional versus compression only CPR in children.

Based on registry data collected from 37 states in the US, this study found that in pediatric patients who experienced out-of-hospital cardiac arrest (OHCA), bystander-initiated cardiopulmonary resuscitation (BCPR) was linked to better survival and favorable neurologic outcomes compared with no BCPR. Conventional BCPR was associated with improved outcomes in both survival and neurologic outcomes, whereas compression-only CPR (COR) was associated with improved survival but not favorable neurologic outcomes. Infants less than 1 year only received benefit from conventional CPR but not from COR. The strength of the study was the large cohort size and the fact that most of the patients were in a relatively narrow age group (<1yr old). The limitations of the study included lack of data on the duration or quality of the CPR being delivered and the observational nature of the study. There was also no data on the etiology of the cardiopulmonary arrest.

Click to read the study, published in JAMA Pediatrics

Relevant Reading: Factors associated with the clinical outcomes of paediatric out-of-hospital cardiac arrest in Japan

In-Depth [retrospective cohort]: This study used registry data from the Cardiac Arrest Registry to Enhance Survival (CARES) database that collected details of cardiac arrests for 37 states. Data was collected from January 2013 to December 2015 and included all non-traumatic cardiac arrest events in which no “do no resuscitate” order existed. All children 18 years of age or younger were included. Neurologic outcome was assessed by the Cerebral Performance Category with a score ≥3 considered unfavorable.

Of the 3,900 OHCA during the study period, 59.4% occurred in infants (<1 year old) with 83.7% occurring at a home/residence and 92.2% having non-shockable rhythms (PEA/asystole). Overall survival was 11.3%, and 9.1% had favorable neurologic outcomes. Bystander CPR was conducted in 46.5% if cases, and occurred more commonly for white children (56.3%) than black (39.4%), or Hispanic (43.4%) children (P<0.001). Bystander CPR was associated with improved survival to hospital discharge (aOR 1.57; 95%CI, 1.25-1.96) and favorable neurologic outcome (aOR 1.54; 95% CI, 1.21-1.98). Conventional CPR was linked to improved survival (aOR 2.23, 95% CI 1.69-2.95) and neurologic outcomes (aOR 2.06, 95%CI, 1.51-2.79), whereas COR was only associated with improved survival (aOR 1.14, 95%CI 1.05-1.97) and not improved neurologic outcomes.

Image: PD

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