CPR from bystanders associated with better outcomes after out-of-hospital cardiac arrest in pediatrics

November 12, 2016

Receiving cardiopulmonary resuscitation (CPR) from a bystander - compared with not - was associated with better overall and neurologically favorable survival for children and adolescents who had out-of-hospital cardiac arrest, according to an article published online by JAMA Pediatrics. The study is being presented at the American Heart Association's Scientific Sessions 2016.

Every year in the United States, more than 5,000 children experience out-of-hospital cardiac arrest (OHCA) and the outcome is generally poor, with a mortality rate greater than 90 percent. The American Heart Association (AHA) recommends conventional CPR for pediatric cardiac arrest. However if the bystander is unable or reluctant to perform rescue breathing, the AHA recommends compression-only CPR (COR), noting that delivering COR is better than no CPR.

Maryam Y. Naim, M.D., of Children's Hospital of Philadelphia, and coauthors analyzed data from the Cardiac Arrest Registry to Enhance Survival for OHCAs in children younger than 18 from January 2013 through December 2015.

The study included 3,900 children with OHCA, of whom 2,317 (59.4 percent) were infants, 2,346 (60.2 percent) were female and 3,595 (92.2 percent) had nonshockable heart rhythms. Cardiac arrests that occur in infants are most likely secondary to sudden infant death syndrome, according to the report.

The authors report: Limitations to the study are that the data are observational and causality cannot be established.

"Bystander CPR is associated with improved outcomes in children with OHCA. Conventional BCPR [bystander CPR] is associated with improved outcomes compared with COR [compression-only CPR] and, among infants, there was no benefit of BCPR unless ventilations were provided. Efforts to improve the provision of CPR in minority communities and increasing the use of conventional BCPR may improve outcomes for children with OHCA," the study concludes.
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(JAMA Pediatr. Published online November 12, 2016. doi:10.1001/jamapediatrics.2016.3643; available pre-embargo at the For The Media website.)

Editor's Note: The article contains funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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