Conventional or compression-only CPR for out-of-hospital cardiac arrests in children?

January 01, 0001

Conventional or compression-only CPR for out-of-hospital cardiac arrests in children?

The American Heart Association recommends cardiopulmonary resuscitation (CPR) by bystanders with chest compression only for adults who have cardiac arrests, but not for children. The researchers from Japan and the USA assessed the effect of CPR (conventional with rescue breathing or chest compression only) by bystanders on outcomes after out-of-hospital cardiac arrests in children. In a nationwide, prospective, population-based, observational study, they enrolled 5170 children aged 17 years and younger who had an out-of- hospital cardiac arrest from Jan 1, 2005, to Dec 31, 2007.

3675 (71%) children had arrests of non-cardiac causes and 1495 (29%) cardiac causes. 1551 (30%) received conventional CPR and 888 (17%) compression-only CPR. Data for type of CPR by bystander were not available for 12 children. Children who were given CPR by a bystander had a significantly higher rate of favourable neurological outcome than did those not given CPR (4.5% vs 1.9%; adjusted odds ratio {OR} 2.59). In children aged 1—17 years who had arrests of non-cardiac causes, favourable neurological outcome was more common after bystander CPR than no CPR (5.1% vs 1.5%; OR 4.17). However, conventional CPR produced more favourable neurological outcome than did compression- only CPR (7.2% vs 1.6%; OR 5.54). In children aged 1-17 years who had arrests of cardiac causes, favourable neurological outcome was more common after bystander CPR than no CPR (9.5% vs 4.1%; OR 2.21), and did not differ between conventional and compression-only CPR (9.9% vs 8.9%; OR 1.20). In infants (aged <1 year), outcomes were uniformly poor (1·7% with favourable neurological outcome).

The researchers concluded: "For children who have out-of- hospital cardiac arrests from non-cardiac causes, conventional CPR (with rescue breathing) by bystander is the preferable approach to resuscitation. For arrests of cardiac causes, either conventional or compression-only CPR is similarly effective."

Looks like the conventional method still has benefits and may still be the way to instruct the public, even though compression only appears easier to practice and teach. Time will tell.

For the full abstract, click here.

The Lancet published online 3 March 2010 © 2010 Elsevier Limited
Conventional and chest-compression-only cardiopulmonary resuscitation by bystanders for children who have out-of- hospital cardiac arrests: a prospective, nationwide, population-based cohort study. Tetsuhisa Kitamura, Taku Iwami, Takashi Kawamura, Ken Nagao, Hideharu Tanaka for the implementation working group for All-Japan Utstein Registry of the Fire and Disaster Management Agency. Correspondence to Taku Iwami: [email protected]

Category: K. Circulatory. Keywords: cardiopulmonary resusitation, conventional, chest compression only, bystanders, children, out of hospital, cardiac arrests, cohort study, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 19 March 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.