ArticlesConventional and chest-compression-only cardiopulmonary resuscitation by bystanders for children who have out-of-hospital cardiac arrests: a prospective, nationwide, population-based cohort study
Introduction
Although cardiopulmonary resuscitation (CPR) by bystanders improves survival after out-of-hospital cardiac arrest, most people who have a cardiac arrest do not receive any CPR from bystanders.1 Partly to encourage CPR by bystanders, the American Heart Association (AHA) now recommends CPR with chest compression only (hands only) for people who have an out-of-hospital cardiac arrest of presumed cardiac origin (eg, sudden collapse or collapse after signs consistent with a myocardial infarction) that is witnessed by a bystander.2 Importantly, survival rates after sudden cardiac arrests of presumed cardiac cause in adults are similar after conventional CPR with chest compressions and rescue breathing by a bystander or compression-only CPR by a bystander.3, 4, 5, 6, 7, 8 Additionally, compression-only CPR is easier to teach, learn, and remember than is conventional CPR.2, 9
As for adults, most children who have an out-of-hospital cardiac arrest do not receive CPR by a bystander.10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 By contrast with such cardiac arrests in adults, CPR by bystanders has not been independently associated with improved outcomes in children.12, 13, 14, 15, 16, 17 Many paediatric out-of-hospital cardiac arrests are of respiratory rather than cardiac cause.1, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 Notably, animal studies suggest that CPR with chest compressions plus rescue breathing is better than chest compressions alone for cardiac arrests of respiratory cause.21, 22 Therefore, compression-only CPR by bystanders is not recommended for children.2, 23
We examined whether any type of CPR by bystanders would be associated with favourable neurological outcome after paediatric out-of-hospital cardiac arrests compared with no CPR. We further postulated that conventional CPR by bystanders with rescue breathing would be better than CPR with chest compression only after cardiac arrests with presumed non-cardiac causes, and that either CPR technique by bystanders (compression only and conventional) would be similarly associated with improved outcomes after out-of-hospital cardiac arrest with presumed cardiac causes.
Section snippets
Study design
The All-Japan Utstein registry of the Fire and Disaster Management Agency (FDMA) is a prospective, nationwide, population-based registry system of out-of-hospital cardiac arrests in adults and children, with Utstein-style data collection.24, 25, 26 This observational study enrolled all children aged 17 years and younger who had had an out-of-hospital cardiac arrest and who were treated by emergency medical service personnel and transported to medical institutions from Jan 1, 2005, to Dec 31,
Results
5758 out-of-hospital cardiac arrests in children were documented. The mean yearly population-based incidence of all cases was 8·0 per 100 000 person-years (65·9 per 100 000 person-years for infants <1 year). The incidence was 2·3 per 100 000 person-years with presumed cardiac cause (22·6 per 100 000 person-years for infants), and 5·7 per 100 000 person-years with non-cardiac cause (43·3 per 100 000 person-years for infants). The figure shows an overview of children who had out-of-hospital
Discussion
Data from this large nationwide registry of children who have out-of-hospital cardiac arrests show that CPR by bystanders (including conventional and compression-only CPR) is associated with higher rates of survival than is no bystander CPR, and with survival with favourable neurological outcome. Unlike previous studies that were underpowered to show this important association, our study is sufficiently large to identify the important beneficial effect of bystander CPR on survival outcomes
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