Conventional Versus Compression-Only Versus No Bystander Cardiopulmonary Resuscitation for Pediatric Out-of-Hospital Cardiac Arrest
Background—Conventional cardiopulmonary resuscitation (CPR) (chest compression and rescue breathing) has been recommended for pediatric out-of-hospital cardiac arrest (OHCA) due to the asphyxial nature of the majority of pediatric cardiac arrest events. However, the clinical effectiveness of additional rescue breathing (conventional CPR) compared with compression-only CPR in children is uncertain.
Methods—This was a nationwide population-based study of pediatric OHCA patients, based on data from the All-Japan Utstein Registry. We included all pediatric patients who experienced OHCA in Japan from January 1, 2011, to December 31, 2012. The primary outcome was a favorable neurological state one month after OHCA defined as a Glasgow-Pittsburgh cerebral performance category (CPC) score of 1-2 (corresponding to a Pediatric CPC score of 1-3). Outcomes were compared using logistic regression with univariable and multivariable modeling in the overall cohort and for a propensity-matched subset of patients.
Results—A total of 2,157 patients were included; 417 received conventional CPR, 733 received compression-only CPR, and 1,007 did not received any bystander CPR. Among these patients, 213 (9.9%) survived with a favorable neurological status one month after OHCA, including 108/417 (25.9%) for conventional, 68/733 (9.3%) for compression-only, and 37/1,007 (3.7%) for no bystander CPR. In unadjusted analyses, conventional CPR was superior to compression-only (OR 3.42, 95% CI 2.45 to 4.76; p<0.0001), with a trend favoring conventional CPR that was no longer statistically significant after multivariable adjustment (ORadjusted 1.52, 95% CI 0.93 to 2.49), and with further attenuation of the difference in a propensity matched subset (OR 1.20, 95% CI 0.81to1.77). Both conventional and compression-only CPR were associated with higher odds for neurologically favorable survival compared with no bystander CPR (ORadjusted 5.01, 95% CI 2.98 to 8.57; and ORadjusted 3.29, 95% CI 1.93 to 5.71, respectively).
Conclusions—In this population-based study of pediatric OHCA in Japan, both conventional and compression-only CPR were associated with superior outcomes compared with no bystander CPR. Unadjusted outcomes with conventional CPR were superior to compression-only CPR, with the magnitude of difference attenuated and no longer statistically significant after statistical adjustments. These findings support randomized clinical trials comparing conventional versus compression-only CPR in children, with conventional CPR preferred until such controlled comparative data are available, and either method preferred over no bystander CPR.
- Received June 2, 2016.
- Revision received August 28, 2016.
- Accepted September 13, 2016.