Rescue breathing cardiopulmonary resuscitation (CPR) had superior neurological outcomes compared with compression only or no resuscitation at all in infants, children and adolescents, according to a new analysis published today in the Journal of the American College of Cardiology.
More than 5,000 Americans under the age of 18 go into out-of-hospital cardiac arrest (OHCA) each year. CPR is an emergency life-saving technique used to help a person whose breathing or heart may have stopped. National and state efforts are focused on teaching compression-only CPR (CO-CPR) to increase the likelihood of bystander CPR. While current guidelines recommend CO-CPR for adults with OHCA, children are more likely to experience OHCA caused by asphyxiation, for which CO-CPR may be less effective, leading to poorer neurological outcomes compared to ventilator-assisted resuscitation (RB-CPR).
The data for this study came from the Cardiac Arrest Registry to Enhance Survival (CARES) database, an established collaboration between the Centers for Disease Control and Prevention and the Department of Emergency Medicine at Emory University School of Medicine, which contains records of 145 million people in 28 states in the United States. A total of 10,429 pediatric cases were drawn from January 2013 to December 2019. The age groups included infants (under one year), children (one to 11 years) and adolescents (12 to 18 years). Bystander CPR was defined as administered by a family member, layperson, or layperson with medical training.
Resuscitation in children was most often performed for heart problems (44.4% of cases), respiratory problems (32.8%), drowning (8.8%), drug overdose (1.8%), electrocution or blood loss (both in 0.2%) or other medical causes (11.9%). Cardiac arrests were more common in infants, men, and white and black children compared to children of other races/ethnicities. Family members or laypeople were most likely to perform CO CPR, while lay people with medical training were more likely to perform RB CPR.
Analyzing the data, the researchers found that OHCAs with RB-CPR and CO-CPR independently had better neurological outcomes compared to no CPR at all. However, compared to CO-CPR, RB-CPR was associated with a greater likelihood of favorable neurological outcomes for infants, children, and adolescents. The analysis found that RB-CPR was also associated with a higher survival rate compared to CO-CPR.
Compared to children and adolescents, infants were found to have different outcomes when it came to CO-CPR and RB-CPR. The researchers found that RB-CPR resulted in better outcomes than CO-CPR for all pediatric age groups. However, the researchers also found that performing CO-CPR was better than no CPR in children and adolescents, but not infants; neurologically favorable survival in infants was observed only with RB-CPR. The researchers concluded that RB-CPR should remain the recommended form of CPR for infants.
One of the key findings of our research is that compression-only CPR is currently the most commonly performed type of CPR for pediatric cardiac arrest in the United States. Current public health campaigns are focused on teaching compression-only CPR, and while this has improved outcomes in adults, it may have disadvantaged children, particularly infants who showed no benefit from compression-only CPR. Bystander CPR education should continue to emphasize CPR for those under 18, especially infants, and lay rescuers should learn how to perform CPR on CPR.”
Maryam Y. Naim, MD, MSCE, pediatric cardiac intensive care physician in the department of cardiac intensive care medicine at the Children’s Hospital of Philadelphia, and lead author of the study
“This new study adds important data to the limited published literature on the subject,” said Gene Yong-Kwang Ong, MBBS, consultant in the pediatric emergency medicine department at Kandang Kerbau Hospital in Singapore, and author of the accompanying editorial. . “Given that infants consistently showed the worst clinical outcomes, and with this finding that bystander CPR could improve neurologically favorable survival, it behooves us to investigate in a timely manner. There should be important discussions in light of this data. “
This study has several limitations, including the use of observational data and a lack of data on coordinator instruction, quality of CPR, and lay rescuer training. In addition, the type of bystander CPR listed in the CARES registry was not available for all arrests. The researchers recommend validating the findings in larger studies.
American College of Cardiology
Naim, MY, et al. (2021) Compression-only versus rescue breathing cardiopulmonary resuscitation after out-of-hospital pediatric cardiac arrest. Journal of the American College of Cardiology. doi.org/10.1016/j.jacc.2021.06.042.