Public Release: 

Bystander CPR improves survival, neurological outcomes in US children

CHOP study of out-of-hospital cardiac arrests reveal patterns in techniques used, age differences, racial disparities

Children's Hospital of Philadelphia

Children who suffer cardiac arrest outside a hospital setting are more likely to survive, and to have better neurological outcomes, when they receive bystander cardiopulmonary resuscitation (CPR). Researchers studying a large U.S. registry of cardiac arrests compared outcomes for two bystander resuscitation techniques, and also recommend improving provision of bystander CPR in minority communities to improve outcomes in children.

"Over 5000 children have an out-of-hospital cardiac arrest every year in the United States," said study leader Maryam Y. Naim, MD, of the Cardiac Center at Children's Hospital of Philadelphia (CHOP). "The overall mortality of these arrests remains high, but we know that providing bystander CPR can improve survival. Our study offers more information relevant to saving children's lives."

Naim and colleagues report their results today online in JAMA Pediatrics.

The research team analyzed a subset of data from the Cardiac Arrest Registry to Enhance Survival (CARES), a large national database of non-traumatic cardiac arrests established by the Centers for Disease Control and Prevention. The team evaluated 3900 cases of out-of-hospital cardiac arrest (OHCA) in children up to age 18 from 2013 to 2015. About 60 percent of the arrests occurred in infants, 60 percent in females, and about 84 percent in homes or residences. Nearly three-quarters (72 percent) of the arrests were not witnessed.

Overall, 440 (11.3 percent) of the 3900 children survived, and the majority of those survivors (354 or 9.1 percent of the 3900) had neurologically favorable outcomes. In 46 percent of the 3900 cases, someone provided bystander CPR, most commonly a family member. Children who received bystander CPR had an advantage in overall survival compared to those receiving no bystander CPR--13.2 percent versus 9.5 percent. They also had better rates of neurologically favorable survival--10.3 percent compared to 7.59 percent in those with no bystander CPR.

The researchers also analyzed two types of bystander CPR for 1411 of the total cases in which such data was available, comparing conventional CPR, which includes both chest compressions and rescue breaths, to compression-only CPR. Although both methods are equally effective for adults with out-of-hospital cardiac arrests, the American Heart Association recommends conventional CPR for children. In this study, the first to compare both methods in U.S. children, 49 percent of children who had an OHCA received conventional CPR and 51 percent received compression-only CPR. Importantly, neurologically favorable survival was more likely to occur after conventional CPR than after the compression-only technique.

One other finding relates to infants, who suffer the majority of out-of-hospital cardiac arrests. In infants, conventional CPR showed higher overall survival, and compression-only CPR had rates of survival similar to no bystander CPR.

Finally, the study team found a racial disparity in those receiving bystander CPR. White children were significantly more likely to receive bystander CPR than Black or Hispanic children, similarly to previous findings in adults who receive bystander CPR. "This finding suggests that public health interventions in Black and Hispanic communities should focus on education on how to perform bystander CPR," said Naim.


Formerly funded by the Centers for Disease Control and Prevention, CARES is now supported by the American Red Cross, the American Heart Association, the Medtronic Foundation HeartRescue Program, Physio-Control Corporation, Zoll Corporation, and in-kind support from Emory University. Co-authors with Naim were from CHOP, the Children's Hospital of Los Angeles, Emory University, University of Texas Health Science Center and Sky Ridge Medical Center in Lone Tree, Colo.

Maryam Y. Naim et al, "Association of Bystander Cardiopulmonary Resuscitation with Overall and Neurologically Favorable Survival After Pediatric Out-of-Hospital Cardiac Arrest in the United States: A Report from the CARES Surveillance Registry," JAMA Pediatrics, published Nov. 12, 2016.

About Children's Hospital of Philadelphia: Children's Hospital of Philadelphia was founded in 1855 as the nation's first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals, and pioneering major research initiatives, Children's Hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country. In addition, its unique family-centered care and public service programs have brought the 535-bed hospital recognition as a leading advocate for children and adolescents. For more information, visit

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