While compression-only cardiopulmonary resuscitation (CO-CPR) was the most common type of bystander CPR in pediatric out-of-hospital cardiac arrest (OHCA), cardiopulmonary resuscitation with rescue breathing (RB-CPR) should continue to be the preferred CPR method for pediatric OHCA, according to a study published Aug. 30 in the Journal of the American College of Cardiology.

Maryam Y. Naim, MD, MSCE, et al., compared the survival rate in RB-CPR and CO-CPR after non-traumatic pediatric OHCA in patients 18 years old or younger between 2013 and 2019 in the Cardiac Arrest Registry to Enhance Survival database. The participants were split into age groups: infants less than one year of age, children between 1 and 11 years old, and adolescents 12 to 18 years old. The primary outcome of the study was neurologically favorable survival at hospital discharge.

The results showed that 46.5% of the 13,060 pediatric OHCAs received bystander CPR, with CO-CPR classified as the most common CPR type. RB-CPR and CO-CPR independently had better neurological outcomes compared with no CPR performed at all. However, compared with CO-CPR, RB-CPR was associated with higher odds of favorable neurological outcomes for infants, children and adolescents. The analysis found RB-CPR was also associated with higher odds of overall survival compared with CO-CPR.

Compared with children and adolescents, infants were found to have different outcomes when it came to CO-CPR and RB-CPR. The researchers found RB-CPR resulted in better outcomes than CO-CPR for all pediatric age groups. However, the researchers also found performing CO-CPR was better than no CPR in children and adolescents, but not infants; neurologically favorable survival in infants was only observed with RB-CPR. The researchers concluded that RB-CPR should continue to be the recommended form of CPR for infants.

“Current public health campaigns focus on teaching compression-only CPR, and while this has improved outcomes in adults, it is possible this had disadvantaged children, particularly infants who did not show a benefit in outcome with compression-only CPR,” explains Naim. “Bystander CPR education should continue to emphasize rescue breathing CPR for those under 18, especially infants, and teach lay rescuers how to perform rescue breathing CPR.”

In a related editorial comment, Gene Yong-Kwang Ong, MBBS, explains, “Given that infants were consistently reported to suffer the worst clinical outcomes, and with this finding that bystander rescue breathing CPR could improve neurologically favorable survival, it behooves us to look into this in a timely manner. There needs to be important discussions in light of this data.”

Clinical Topics: Arrhythmias and Clinical EP, Congenital Heart Disease and Pediatric Cardiology, SCD/Ventricular Arrhythmias, CHD and Pediatrics and Arrhythmias

Keywords: Infant, Adolescent, Child, Out-of-Hospital Cardiac Arrest, Health Promotion

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