For children who have cardiac arrests outside of a hospital, cardiopulmonary resuscitation (CPR) by bystanders increases the likelihood of survival. CPR that includes chest compressions with rescue breathing is more important for non-cardiac causes of cardiac arrest, such as drowning, than chest compressions alone. These are the conclusions of a study published Online First by Dr Taku Iwami, Kyoto University Health Service, Kyoto, Japan, and colleagues.
The American Heart Association recommends CPR by bystanders with chest compression only for adults who have cardiac arrests outside of a hospital, since it has been shown to improve survival rates. However, most previous studies have not had a large enough sample size to show such an association for children.
In this nationwide, population-based cohort study, the researchers enrolled 5170 children aged 17 years or younger who had had a cardiac arrest outside of a hospital. They obtained data on whether or not the children had been given CPR, and if so, whether or not it was compression-only CPR or CPR with rescue breathing. The primary endpoint was a favourable neurological outcome at 1 month after the cardiac arrest as defined by a Glasgow-Pittsburgh cerebral performance category of 1 (good performance) or 2 (moderate disability).
A favourable neurological outcome was about three times more likely for children who had been given any CPR by a bystander than for those who had not. In children whose cardiac arrests had a non-cardiac cause, conventional CPR (ie, with rescue breathing) was more likely to improve survival than compression-only CPR. For children whose arrests were cardiac in cause, both types of CPR had the same effect.
The authors say: "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 after paediatric cardiac arrest."
They conclude: "Our data lead us to lend support to a double CPR training strategy: compression-only CPR training for most people to increase bystander 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."
In an accompanying Comment, Dr Jesús López-Herce and Dr Angel Carrillo Alvarez, Pediatric Intensive Care Service, Hospital General Universitario Gregorio, Madrid, Spain, say that this study "confirms that early bystander-initiated CPR is one of the fundamental factors to improve prognosis, in adults and children."
They say that Iwami et al's data: "underline the importance of not extrapolating findings from adults to children, because cardiac arrest in children has specific characteristics. In adults, 65% of out-of-hospital cardiac arrests are of cardiac origin, whereas in children at least 71% are of non-cardiac origin. 71% is probably an underestimate because the diagnosis of cardiac origin was by exclusion in today's study and, in other studies, cardiac causes accounted for less than 10% of cases."
They conclude: "Chest compression plus ventilation should continue to be the standard, a technique that should be taught to the whole population."
Dr Taku Iwami, Kyoto University Health Service, Yoshida-Honmachi, Sakyo-ku, Kyoto 606-8501, Japan. T) +81-75-753-2426 E) iwamit@e-mail.jp
Dr Jesús López-Herce and Angel Carrillo Alvarez, Pediatric Intensive Care Service, Hospital General Universitario Gregorio, Madrid, Spain. E) pielvi@ya.com
For full Article and Comment, see: http://press.thelancet.com/cpr.pdf
Journal
The Lancet