CPR with rescue breathing preferable to compression only in pediatric cardiac arrest
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After out-of-hospital cardiac arrest, pediatric recipients of rescue breathing with CPR had better outcomes compared with those in their age group who received compression-only CPR, researchers reported.
Despite this, “compression-only CPR is currently the most commonly performed type of CPR for pediatric cardiac arrest in the United States,” Maryam Y. Naim, MD, MSCE, pediatric intensive care physician at the Children’s Hospital of Philadelphia and assistant professor of pediatrics, anesthesiology and critical care at Perelman School of Medicine at the University of Pennsylvania, said in a press release.
Naim and colleagues performed the study to test whether CPR with rescue breathing (RB-CPR) yielded improved neurologically favorable survival compared with compression-only CPR (CO-CPR) after pediatric out-of-hospital cardiac arrest (OHCA), and to determine age-stratified outcomes with CPR type compared with no bystander CPR (NO-CPR).
The researchers analyzed the CARES registry for nontraumatic pediatric OHCAs between 2013 and 2019. They categorized groups as infants (younger than 1 year), children (aged 1 to 11 years) and adolescents (aged 12 to 17 years).
Neurologically favorable survival at hospital discharge served as the primary outcome.
Rescue breathing beneficial
Overall, 13,060 pediatric OHCAs were included in the study, of which 46.5% of patients received bystander CPR. Researchers found that CO-CPR was the most common bystander CPR type.
Compared with NO-CPR, RB-CPR (adjusted OR = 2.16; 95% CI, 1.78-2.62) and CO-CPR (aOR = 1.61; 95% CI, 1.34-1.94) were linked to neurologically favorable survival. Moreover, RB-CPR yielded an increased likelihood of neurologically favorable survival compared with CO-CPR (aOR = 1.36; 95% CI, 1.1-1.68).
According to age-stratified analysis, all age groups demonstrated better neurologically favorable survival with RB-CPR compared with NO-CPR. For those who received CO-CPR compared with NO-CPR, neurologically favorable survival was improved in children and adolescents, but not infants.
“While public health efforts to teach compression-only CPR have benefited adults who have cardiac arrests, children have likely been disadvantaged by these efforts,” Naim said in a separate press release. “The results of this study have important implications on bystander CPR education and training, which should continue to emphasize rescue breathing CPR for children — and especially infants — in cardiac arrest and teach lay rescuers how to perform this type of CPR.”
Timely assessment needed
In an accompanying editorial, Gene Yong-Kwang Ong, MBBS, of the KK Women’s and Children’s Hospital in Singapore, noted the inherent limitations to the data of cohort observational studies derived from cardiac arrest registries while acknowledging that controlled trials for bystander chest compressions are unlikely in the pediatric population.
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