Among patients aged 1–17 years with primary cardiac arrest, conventional CPR and compression-only CPR similarly improved outcomes over no bystander CPR, but for children with noncardiac causes of arrest, conventional CPR was better.
Compression-only cardiopulmonary resuscitation (CPR) has been shown to be as effective as conventional CPR for adults, in whom most arrests are of primary cardiac origin (JW Emerg Med Mar 30 2007), but is compression-only CPR useful for children, who are much more likely to arrest from respiratory causes? Researchers in Japan analyzed data from a nationwide, prospective observational database for 5170 children (age, 17 years) with out-of-hospital cardiac arrest (71% noncardiac etiology, 29% cardiac etiology). Bystander CPR was provided to 47% of children; 30% received conventional CPR, and 17% received chest compressions only without rescue breathing.
The primary endpoint was favorable neurological outcome (defined as Glasgow-Pittsburgh cerebral performance category 1 or 2) 1 month after arrest. Multiple logistic regression analysis revealed that favorable neurological outcome was significantly more likely for children who received bystander CPR than for those who did not (4.5% vs. 1.9%), for patients aged 1–17 years than for infants younger than 1 year (4.1% vs. 1.7%), for those with ventricular fibrillation as the initial rhythm than for those with other rhythms (20.6% vs. 2.3%), and for those with witnessed arrest (by family or others) than for those with unwitnessed arrest (6.7% and 10.3%, respectively, vs. 1.3%). In children aged 1–17 years, rates of favorable neurological outcome were significantly higher with conventional CPR than with compression-only CPR among patients with noncardiac causes of arrest (7.2% vs. 1.6%), but rates did not differ by type of CPR among patients with cardiac causes of arrest. Neurological outcomes were poor in infants (age, <1 year), regardless of type of CPR or etiology of arrest.
Bystander CPR, particularly for witnessed arrest, greatly improves meaningful survival in adults and children. Compression-only CPR is a reasonable alternative for adults and might increase the likelihood that CPR is performed. However, children's arrests are usually from noncardiac causes, and conventional CPR clearly is superior to compression-only CPR in such cases. For a bystander, determining a cardiac versus a noncardiac cause for an arrest is almost impossible, so the recommendation is clear: Conventional CPR for children up to age 17!
Kristi L. Koenig, MD, FACEP
Published in Journal Watch Emergency Medicine March 2, 2010
Kitamura T et al. 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. Lancet 2010 Mar 3; [e-pub ahead of print]. (http://dx.doi.org/10.1016/S0140-6736(10)60064-5)
López-Herce J and Álvarez AC. Bystander CPR for paediatric out-of-hospital cardiac arrest. Lancet 2010 Mar 3; [e-pub ahead of print]. (http://dx.doi.org/10.1016/S0140-6736(10)60316-9)