Elsevier

The Lancet

Volume 375, Issue 9723, 17–23 April 2010, Pages 1347-1354
The Lancet

Articles
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

https://doi.org/10.1016/S0140-6736(10)60064-5Get rights and content

Summary

Background

The American Heart Association recommends cardiopulmonary resuscitation (CPR) by bystanders with chest compression only for adults who have cardiac arrests, but not for children. We assessed the effect of CPR (conventional with rescue breathing or chest compression only) by bystanders on outcomes after out-of-hospital cardiac arrests in children.

Methods

In a nationwide, prospective, population-based, observational study, we enrolled 5170 children aged 17 years and younger who had an out-of-hospital cardiac arrest from Jan 1, 2005, to Dec 31, 2007. Data collected included age, cause, and presence and type of CPR by bystander. The primary endpoint was favourable neurological outcome 1 month after an out-of-hospital cardiac arrest, defined as Glasgow-Pittsburgh cerebral performance category 1 or 2.

Findings

3675 (71%) children had arrests of non-cardiac causes and 1495 (29%) cardiac causes. 1551 (30%) received conventional CPR and 888 (17%) compression-only CPR. Data for type of CPR by bystander were not available for 12 children. Children who were given CPR by a bystander had a significantly higher rate of favourable neurological outcome than did those not given CPR (4·5% [110/2439] vs 1·9% [53/2719]; adjusted odds ratio [OR] 2·59, 95% CI 1·81–3·71). In children aged 1–17 years who had arrests of non-cardiac causes, favourable neurological outcome was more common after bystander CPR than no CPR (5·1% [51/1004] vs 1·5% [20/1293]; OR 4·17, 2·37–7·32). However, conventional CPR produced more favourable neurological outcome than did compression-only CPR (7·2% [45/624] vs 1·6% [six of 380]; OR 5·54, 2·52–16·99). In children aged 1–17 years who had arrests of cardiac causes, favourable neurological outcome was more common after bystander CPR than no CPR (9·5% [42/440] vs 4·1% [14/339]; OR 2·21, 1·08–4·54), and did not differ between conventional and compression-only CPR (9·9% [28/282] vs 8·9% [14/158]; OR 1·20, 0·55–2·66). In infants (aged <1 year), outcomes were uniformly poor (1·7% [36/2082] with favourable neurological outcome).

Interpretation

For children who have out-of-hospital cardiac arrests from non-cardiac causes, conventional CPR (with rescue breathing) by bystander is the preferable approach to resuscitation. For arrests of cardiac causes, either conventional or compression-only CPR is similarly effective.

Funding

Fire and Disaster Management Agency and the Ministry of Education, Culture, Sports, Science and Technology (Japan).

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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