Study on impact of bystander CPR on pediatric cardiac arrest

Bystanders who perform cardiopulmonary resuscitation (CPR) on a child with cardiac arrest increase the child's likelihood of survival, according to the largest pediatric study to date. The outcomes are similar for both chest compression alone (hands-only) CPR and CPR with chest compression and rescue breathing.

CPR was more effective when rescue breathing was combined with chest compressions for children with cardiac arrest from non-cardiac causes, such as trauma, near-drowning or respiratory problems.  Nevertheless, say the authors, because most children suffering cardiac arrest outside a hospital receive no bystander CPR, even compression-only CPR is preferable to no CPR.

The study, Bystander-initiated Conventional and Chest Compression-only Cardiopulmonary Resuscitation for Pediatric Out-of-hospital Cardiac Arrests, was published online today by the medical journal, The Lancet. Lead authors are Tetsuhisa Kitamura, M.D., Taku Iwami, M.D., and Takashi Kawamura, M.D., of  Kyoto University Health Service. Two prominent U.S. pediatric CPR researchers from The Children's Hospital of Philadelphia, Robert Berg M.D. and Vinay Nadkarni M.D. collaborated to study, analyze and interpret data and co-author the final report.

This is the largest study of children to identify the important beneficial impact of bystander CPR on pediatric cardiac arrest survival outcomes. Importantly, the relative value of rescue breathing during bystander-initiated CPR depends on the cause of the arrest, whether from an underlying heart condition, or a non-cardiac cause such as sudden trauma, near drowning or respiratory illness.

"This study is the first large study to specifically confirm that CPR with rescue breathing is the best approach for a cardiac arrest from respiratory problems in children," said Robert A. Berg, M.D., chief of Critical Care Medicine at the Children's Hospital of Philadelphia. "Our study is also sufficiently large to identify the important beneficial effect of any bystander CPR on survival outcomes after pediatric cardiac arrest."

The American Heart Association recommends bystanders who are not trained or willing to provide rescue breathing with CPR to provide "hands-only" chest compressions for adults who have cardiac arrests outside of a hospital. However, previous studies have not had a large enough sample size or enough children included to evaluate this strategy for children.

These researchers enrolled 5,170 children ages 1 through 17 who had had an out-of-hospital cardiac arrest in Japan. They compared whether or not the children had been given CPR, and if so, whether CPR was compression-only or CPR with rescue breathing.

Children receiving any CPR were three times more likely to have better survival outcomes (4.5 percent of those patients receiving CPR had a favorable outcome compared with 1.9 percent who received no CPR). In children whose cardiac arrests had a non-cardiac cause, conventional CPR with rescue breathing was more likely to improve survival than compression-only CPR. (7.2 percent compared with 1.6 percent).  For children whose arrests were cardiac in cause, both types of CPR had the same effect.

"CPR with rescue breathing should continue to be taught as the gold standard for those who care for children and who have a duty to respond," said Vinay Nadkarni, M.D., another co-author of the study and medical director of the Center for Simulation, Advanced Education and Innovation at Children's Hospital. "Most importantly, if you witness a child suddenly collapse, such as an athlete on the field, and suspect cardiac arrest, perform at least chest compressions until medical help and a defibrillator arrives."

The study authors encourage a two-pronged CPR training strategy: hands-only CPR training for everyone, to increase CPR by bystanders, and conventional CPR (chest-compression plus rescue breathing) training for individuals who are most likely to  witness children who have cardiac arrests with non-cardiac causes, such as medical professionals, lifeguards, school teachers, families with children, and families with swimming pools.