Conventional CPR in Pedi Arrest Bests Compression-Only

Short Attention Span Summary

CPR improves pedi arrest outcomes.
Bystander CPR for out of hospital pediatric arrest was associated with an overall 50% greater odds of neurologically favorable survival in this large pediatric arrest registry.  When type of CPR was considered, only conventional CPR (breaths and compressions) was associated with improved neurologically intact survival compared to compression-only CPR.

Spoon Feed
Bystander CPR improved the odds of neurologically intact survival in pediatric patients, but only if conventional CPR was performed.  This is in contrast to yesterday's article found that any CPR, even compression-only was better than no CPR in pediatric out of hospital arrest.


Abstact

JAMA Pediatr. 2016 Nov 12. doi: 10.1001/jamapediatrics.2016.3643. [Epub ahead of print]

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 Cardiac Arrest Registry to Enhance Survival Surveillance Registry.

Naim MY1, Burke RV2, McNally BF3, Song L4, Griffis HM4, Berg RA5, Vellano K3, Markenson D6, Bradley RN7, Rossano JW8.

Author information:

1The Cardiac Center, The Children's Hospital of Philadelphia, Perelman School of Medicine, The University of Pennsylvania, Philadelphia.

2Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles.

3Department of Emergency Medicine, Emory University, Atlanta, Georgia.

4Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness and PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.

5Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia.

6Sky Ridge Medical Center, Lone Tree, Colorado.

7Division of Emergency Medicine, University of Texas Health Science Center, Houston.

8The Cardiac Center, The Children's Hospital of Philadelphia, Perelman School of Medicine, The University of Pennsylvania, Philadelphia8Leonard Davis Institute, University of Pennsylvania, Philadelphia.

Abstract

Importance:

There are few data on the prevalence or outcome of bystander cardiopulmonary resuscitation (BCPR) in children 18 years and younger.

Objective:

To characterize BCPR in pediatric out-of-hospital cardiac arrests (OHCAs).

Design, Setting, and Participants:

This analysis of the Cardiac Arrest Registry to Enhance Survival database investigated nontraumatic OHCAs in children 18 years and younger from January 2013 through December 2015.

Exposures:

Bystander CPR, which included conventional CPR and compression-only CPR.

Main Outcomes and Measures:

Overall survival and neurologically favorable survival, defined as a Cerebral Performance Category score of 1 or 2, at the time of hospital discharge.

Results:

Of the 3900 children younger than 18 years with OHCA, 2317 (59.4%) were infants, 2346 (60.2%) were female, and 3595 (92.2%) had nonshockable rhythms. Bystander CPR was performed on 1814 children (46.5%) and was more common for white children (687 of 1221 [56.3%]) compared with African American children (447 of 1134 [39.4%]) and Hispanic children (197 of 455 [43.3%]) (Pā€‰<ā€‰.001). Overall survival and neurologically favorable survival were 11.3% (440 of 3900) and 9.1% (354 of 3900), respectively. On multivariable analysis, BCPR was independently associated with improved overall survival (adjusted proportion, 13.2%; 95% CI, 11.81-14.58; adjusted odds ratio, 1.57; 95% CI, 1.25-1.96) and neurologically favorable survival (adjusted proportion, 10.3%; 95% CI, 9.10-11.54; adjusted odds ratio, 1.50; 95% CI, 1.21-1.98) compared with no BCPR (overall survival: adjusted proportion, 9.5%; 95% CI, 8.28-10.69; neurologically favorable survival: adjusted proportion, 7.59%; 95% CI, 6.50-8.68). For those with data on type of BCPR, 697 of 1411 (49.4%) received conventional CPR and 714 of 1411 (50.6%) received compression-only CPR. On multivariable analysis, only conventional CPR (adjusted proportion, 12.89%; 95% CI, 10.69-15.09; adjusted odds ratio, 2.06; 95% CI, 1.51-2.79) was associated with improved neurologically favorable survival compared with no BCPR (adjusted proportion, 9.59%; 95% CI, 6.45-8.61). There was a significant interaction of BCPR with age. Among infants, conventional BCPR was associated with improved overall survival and neurologically favorable survival while compression-only CPR had similar outcomes to no BCPR.

Conclusions and Relevance:

Bystander CPR is associated with improved outcomes in pediatric OHCAs. Improving the provision of BCPR in minority communities and increasing the use of conventional BCPR may improve outcomes for children with OHCA.

PMID: 27837587 [PubMed - as supplied by publisher]