Title: Conventional and Chest-Compression-Only Cardiopulmonary Resuscitation by Bystanders for Children Who Have Out-of-Hospital Cardiac Arrests: A Prospective, Nationwide, Population-Based Cohort Study
Topic: Arrhythmias
Date Posted: 5/21/2010
Author(s): Kitamura T, Iwami T, Kawamura T, et al., on behalf of the Implementation Working Group for All-Japan Utstein Registry of the Fire and Disaster Management Agency.
Citation: Lancet 2010;375:1347-1354.
Clinical Trial: No
Study Question: What is the optimal type of cardiopulmonary resuscitation (CPR) for pediatric patients with out-of-hospital cardiac arrest (OHCA)?
Methods: The data in this study were obtained from a nationwide registry of OHCAs in Japan. Children ages 17 years or younger were included in the study. The 1° outcome was favorable neurological outcome at 1 month of follow-up.
Results: Data from 5,170 children with OHCA were analyzed. The OHCA was from a noncardiac cause in 71% of patients. One-month survival with favorable neurological outcome was 3.2%. Twenty-seven percent of the OHCAs were witnessed by bystanders. When there was a noncardiac cause of OHCA, the 1° outcome was significantly more frequent after bystander CPR (5.1%) than with no bystander CPR (1.5%) and after conventional CPR (7.2%) than after compression-only CPR (1.6%). When there was a cardiac cause of OHCA, the incidence of the 1° outcome was significantly higher with bystander CPR (9.5%) than without bystander CPR (4.1%), but did not differ significantly after conventional CPR (9.9%) versus compression-only CPR (8.9%).
Conclusions: Rescue breaths provide incremental value compared to compression-only CPR in children with OHCA, but only when the cardiac arrest results from a noncardiac etiology.
Perspective: Observational studies in adults have indicated that compression-only CPR yields similar or better outcomes than does conventional CPR in adults with OHCA, and the American Heart Association now recommends compression-only CPR for OHCA of presumed cardiac origin. In children, OHCA is more often noncardiac in etiology (e.g., drowning, trauma, respiratory disease) than in adults. Therefore, unless there is a witnessed sudden collapse consistent with a cardiac-based OHCA, conventional CPR with rescue breaths is indicated. Fred Morady, M.D., F.A.C.C.
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