CPR in Kids - Conventional or Compression-Only

Short Attention Span Summary

Compressions and rescue breaths for kids
This large cardiac arrest database out of Japan found that unadjusted rates of neurologically intact survival were better in children who received conventional CPR (compressions + rescue breaths), with 26% survival, vs compression-only CPR, with 9.3% survival.  After statistical adjustments, the results were no longer significantly different.  But there was certainly a trend favoring provision of rescue breaths in kids.  Both types of CPR were superior to no CPR in kids, adjusted odds ratio for neurologically intact survival 5.01 for conventional and 3.29 for compression only.

Spoon Feed
Though this study isn't definitive, taken with the article we will discuss tomorrow, conventional CPR is preferred over compression-only CPR in pediatric arrest.  Tomorrow we will look at an even larger study on the same subject from the US.


Abstract

Circulation. 2016 Nov 22. pii: CIRCULATIONAHA.116.023831. [Epub ahead of print]

Conventional Versus Compression-Only Versus No Bystander Cardiopulmonary Resuscitation for Pediatric Out-of-Hospital Cardiac Arrest.

Fukuda T1, Ohashi-Fukuda N2, Kobayashi H3, Gunshin M4, Sera T5, Kondo Y6, Yahagi N2.

Author information:

1Department of Emergency and Critical Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan tatsumafukuda-jpn@umin.ac.jp.

2Department of Emergency and Critical Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

3Department of Emergency and Critical Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan & Stephen M. Ross School of Business at the University of Michigan, Ann Arbor, MI.

4Department of Disaster Medical Management, The University of Tokyo Hospital, Tokyo, Japan & The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

5Department of Acute Critical Care and Disaster Medicine, Tokyo Medical and Dental University, Tokyo, Japan.

6Department of Emergency Medicine, Graduate School of Medicine, University of Ryukyus, Okinawa, Japan & Division of Acute Care Surgery, Trauma, and Surgical Critical Care, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.

Abstract

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 (OR adjusted 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 0.81 to 1.77). Both conventional and compression-only CPR were associated with higher odds for neurologically favorable survival compared with no bystander CPR (OR adjusted 5.01, 95% CI 2.98 to 8.57; and OR adjusted 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.

PMID: 27881563 [PubMed - as supplied by publisher]