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Original Investigation
February 2017

Association of Bystander Cardiopulmonary Resuscitation With Overall and Neurologically Favorable Survival After Pediatric Out-of-Hospital Cardiac Arrest in the United StatesA Report From the Cardiac Arrest Registry to Enhance Survival Surveillance Registry

Author Affiliations
  • 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
  • 8Leonard Davis Institute, University of Pennsylvania, Philadelphia
JAMA Pediatr. 2017;171(2):133-141. doi:10.1001/jamapediatrics.2016.3643
Key Points

Question  What are the characteristics and outcomes of bystander cardiopulmonary resuscitation (CPR) and compression-only CPR following pediatric out-of-hospital cardiac arrest?

Findings  In this analysis of data from the Cardiac Arrest Registry to Enhance Survival, bystander CPR was provided in 1814 of 3900 instances (46.5%) of out-of-hospital cardiac arrests in children younger than 18 years and was significantly associated with improved overall survival and neurologically favorable survival. Conventional CPR had improved outcomes compared with compression-only CPR.

Meaning  Public health efforts to improve the provision of CPR in minority communities and increase the use of conventional bystander CPR may improve outcomes for pediatric out-of-hospital cardiac arrests.

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%]) (P < .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.

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