Children are more likely to survive and have better neurological outcomes after cardiac arrest outside of a hospital when they receive cardiopulmonary resuscitation (CPR) from a bystander, according to a new study in JAMA Pediatrics.
More than 5,000 children suffer nontraumatic out-of-hospital cardiac arrests each year, according to the American Heart Association (AHA). Bystander CPR is an important element of survival of pediatric cardiac arrests outside of hospitals, yet only one-third to one-half of victims receive bystander CPR.
The goal of the study was to help public health efforts aimed at improving the provision of CPR in minority communities and increase the use of bystander CPR (BCPR) in all communities. A research team analyzed data retrieved from the Cardiac Arrest Registry to Enhance Survival (CARES). The registry, established by the Centers for Disease Control and Prevention (CDC), is a large national database containing information about nontraumatic cardiac arrests.
"The overall mortality of these arrests remains high, but we know that providing bystander CPR can improve survival," study leader Maryam Y. Naim, MD, of the Cardiac Center at Children’s Hospital of Philadelphia (CHOP) said in a news release. "Our study offers more information relevant to saving children’s lives."
The researchers determined the number of children receiving BCPR, survival rates and neurological outcomes. The team also compared outcomes for two bystander resuscitation techniques — conventional CPR and compression-only CPR.
The researchers looked at information gathered from 3,900 children, aged 18 years and younger, entered into the database from January 2013 through December 2015. Of the children entered into the study, 59.4 percent were infants, 60.2 percent were female and 92.2 percent had nonshockable rhythms. Nearly three-quarters of cases were not witnessed.
Bystanders performed CPR in 46.5 percent of the cases included in the study. The results of the study showed bystander CPR improved overall survival and neurological outcomes in children suffering out-of-hospital cardiac arrest (OHCA). Overall, 11.3 percent of the children survived, and most of the survivors had favorable neurological outcomes.
Children who received BCPR had a 13.2 percent survival rate, whereas those who did not receive bystander CPR had only a 9.5 percent survival rate. At 10.3 percent compared to 7.59 percent, children who received BCPR also had better rates of neurologically favorable survival than did patients that did not receive CPR from a bystander.
Patients who received conventional CPR enjoyed better outcomes than did those who received hands-only CPR. While the two methods are equally effective for adult patients suffering out-of-hospital cardiac arrests, AHA recommends conventional CPR for pediatric patients. This study is the first to compare both methods in U.S. children suffering from OHCA.
Forty-nine percent of the study subjects received conventional CPR, which includes respirations, while 51 percent received CPR featuring only compression. The researchers found that conventional CPR was more likely to result in neurologically favorable survival than was the compression-only technique.
The researchers also found that infants, who suffered the majority of OHCAs in the study, had overall higher survival rates with conventional CPR. Infants receiving compression-only CPR had survival rates similar to infants who did not receive CPR from a bystander.
Bystander CPR was more common for white children at 56.3 percent than for African-American children at 39.4 percent and Hispanic children at 43.3 percent.
The authors of the study also recommend improving utilization of bystander CPR in minority communities to improve survival and neurological outcomes in children there. Interventions should focus on education that teaches the public how to perform bystander CPR.
