Study shows that in infants experiencing cardiac arrest, bystander CPR using only chest compression has similar outcomes to not using CPR at all
Peer-Reviewed PublicationIMAGE: MARYAM Y. NAIM, MD, MSCE, A PEDIATRIC CARDIAC INTENSIVE CARE PHYSICIAN IN THE DIVISION OF CARDIAC CRITICAL CARE MEDICINE AT CHILDREN'S HOSPITAL OF PHILADELPHIA AND FIRST AUTHOR OF THE STUDY view more
CREDIT: CHILDREN'S HOSPITAL OF PHILADELPHIA
Philadelphia, August 30, 2021—When children and adolescents go into cardiac arrest outside of a hospital setting, CPR with rescue breathing – rather than CPR using only chest compressions – leads to better outcomes, according to a new study by researchers at Children’s Hospital of Philadelphia (CHOP). The findings, published today in the Journal of the American College of Cardiology, support the use of bystander CPR with rescue breathing in children experiencing cardiac arrest.
“At the moment, most lay people are trained in compression-only CPR because that is the standard of care in adults,” said Maryam Y. Naim, MD, MSCE, a pediatric cardiac intensive care physician in the Division of Cardiac Critical Care Medicine at Children's Hospital of Philadelphia and first author of the study. “However, children are not simply small adults, and our study shows there is a tremendous need for education in all communities about the benefits of CPR with rescue breathing in the pediatric population. For infants in particular, our study shows that CPR with rescue breathing is the only type of CPR that is associated with good neurological outcomes; infants who received compression-only CPR had similar outcomes to infants who did not receive bystander CPR.”
Fewer than 10% of children who experience cardiac arrest outside of a hospital setting survive. The rates of survival improve when a bystander performs CPR, but prior to this study, the frequency and type of bystander CPR in out-of-hospital pediatric cardiac arrest in different age groups was unknown. In adults, compression-only CPR has been shown to be as effective as CPR with rescue breathing, so since 2010, the American Heart Association (AHA) and European Resuscitation Council (ERC) have recommended compression-only CPR for bystanders who witness an adult in cardiac arrest. However, the researchers suspected this form of CPR might be less effective in children, as pediatric cardiac arrest most often stems from breathing problems.
To better understand the frequency, type, and outcomes of bystander CPR for children, the researchers analyzed 10,429 out-of-hospital cardiac arrests between 2013 and 2019 in patients between 0 and 18 years of age. The data for the study was derived from the Cardiac Arrest Registry to Enhance Survival (CARES) database, a registry maintained by the Centers for Disease Control and Prevention in collaboration with the Department of Emergency Medicine at the Emory University School of Medicine, which includes an overall catchment area of nearly 145 million people in 28 states across the United States.
The researchers found that less than half (46.5%) of those who experienced pediatric cardiac arrest outside of the hospital received bystander CPR. Of those who did receive CPR, the majority (55.6%) received compression-only CPR. Those children who received CPR with rescue breathing were nearly 1.5 times as likely to have better neurological outcomes than those who received compression-only CPR. In children and adolescents, both types of CPR had better neurological outcomes than no CPR at all, but to the researchers’ surprise, infants receiving compression-only CPR had essentially the same outcomes as infants who received no CPR.
Additionally, the researchers examined the changes in rates and types of CPR over the six-year study period and found that although the rates of bystander CPR did not change, the proportion of compression-only CPR increased, with no change in neurologically favorable survival.
“While public health efforts to teach compression-only CPR have benefited adults who have cardiac arrests, children have likely been disadvantaged by these efforts. 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,” Naim said.
Naim et al. “Compression-only versus Rescue-breathing Bystander Cardiopulmonary Resuscitation in Pediatric Out-of-Hospital Cardiac Arrests,” Journal of the American College of Cardiology, online August 30, 2021, DOI: 10.1016/j.jacc.2021.06.042
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About Children’s Hospital of Philadelphia: Children’s Hospital of Philadelphia was founded in 1855 as the nation’s first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals, and pioneering major research initiatives, Children’s Hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country. In addition, its unique family-centered care and public service programs have brought the 595-bed hospital recognition as a leading advocate for children and adolescents. For more information, visit http://www.chop.edu
JOURNAL
Journal of the American College of Cardiology
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Compression-only versus Rescue-breathing Bystander Cardiopulmonary Resuscitation in Pediatric Out-of-Hospital Cardiac Arrests
ARTICLE PUBLICATION DATE
30-Aug-2021
Mouth-to-mouth bystander CPR preferable method for pediatric cardiac arrest
Compression-only CPR still recommended for adults
Peer-Reviewed PublicationRescue breathing cardiopulmonary resuscitation (CPR) had superior neurological outcomes compared with compression-only CPR or no CPR at all in infants, children and adolescents, according to a new analysis published today in the Journal of the American College of Cardiology.
Over 5,000 Americans under the age of 18 experience an out-of-hospital cardiac arrest (OHCA) each year. CPR is a life-saving emergency technique used to help a person whose breathing or heart may have stopped. National and statewide efforts focus on teaching compression-only CPR (CO-CPR) to improve the likelihood of bystander CPR. While current guidelines recommend CO-CPR for adults with OHCA, children more commonly experience OHCA caused by asphyxiation for which CO-CPR may be less effective, leading to worse neurological outcomes compared to rescue breathing CPR (RB-CPR).
Data for this study came from the Cardiac Arrest Registry to Enhance Survival (CARES) database, an established collaboration between the Centers for Disease Control and Prevention and the Department of Emergency Medicine at Emory University School of Medicine, which includes data from 145 million people in 28 states across the United States. A total of 10,429 pediatric cases were pulled from January 2013 to December 2019. Age groups included infants (less than one year of age), children (one to 11 years) and adolescents (12 to 18 years). Bystander CPR was defined as being administered by a family member, layperson, or a layperson with medical training.
Pediatric CPR was most commonly performed due to cardiac problems (44.4% of cases), respiratory problems (32.8%), drowning (8.8%), drug overdose (1.8%), electrocution or exsanguination (both at 0.2%) or other medical causes (11.9%). Cardiac arrests were more common in infants, males, and white and Black children compared to children of other races/ethnicities. Family members or laypersons were most likely to perform CO-CPR, whereas laypersons with medical training were more likely to perform RB-CPR.
In analyzing the data, the researchers found that OHCAs with RB-CPR and CO-CPR independently had better neurological outcomes compared with no CPR performed at all. However, compared with CO-CPR, RB-CPR was associated with higher odds of favorable neurological outcomes for infants, children and adolescents. The analysis found RB-CPR was also associated with higher odds of overall survival compared with CO-CPR.
Compared with children and adolescents, infants were found to have different outcomes when it came to CO-CPR and RB-CPR. The researchers found RB-CPR resulted in better outcomes than CO-CPR for all pediatric age groups. However, the researchers also found performing CO-CPR was better than no CPR in children and adolescents, but not infants; neurologically favorable survival in infants was only observed with RB-CPR. The researchers concluded that RB-CPR should continue to be the recommended form of CPR for infants.
“One of the most important findings of our investigation is that compression-only CPR is currently the most commonly performed type of CPR for pediatric cardiac arrest in the United States,” said Maryam Y. Naim, MD, MSCE, a pediatric cardiac intensive care physician in the division of cardiac critical care medicine at Children’s Hospital of Philadelphia, and lead author of the study. “Current public health campaigns focus on teaching compression-only CPR, and while this has improved outcomes in adults, it is possible this had disadvantaged children, particularly infants who did not show a benefit in outcome with compression-only CPR. Bystander CPR education should continue to emphasize rescue breathing CPR for those under 18, especially infants, and teach lay rescuers how to perform rescue breathing CPR.”
“This new study adds important data to the limited published literature on this topic,” said Gene Yong-Kwang Ong, MBBS, consultant in the department of pediatric emergency medicine in Kandang Kerbau Hospital in Singapore, and author of the accompanying editorial comment. “Given that infants were consistently reported to suffer the worst clinical outcomes, and with this finding that bystander rescue breathing CPR could improve neurologically favorable survival, it behooves us to look into this in a timely manner. There needs to be important discussions in light of this data.”
This study has several limitations, including utilizing observational data, and a lack of data on dispatcher instruction, the quality of CPR and training of the lay rescuer. In addition, the type of bystander CPR included in CARES registry was not available for all arrests. The researchers recommend the findings to be validated in larger studies.
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The American College of Cardiology envisions a world where innovation and knowledge optimize cardiovascular care and outcomes. As the professional home for the entire cardiovascular care team, the mission of the College and its 54,000 members is to transform cardiovascular care and to improve heart health. The ACC bestows credentials upon cardiovascular professionals who meet stringent qualifications and leads in the formation of health policy, standards and guidelines. The College also provides professional medical education, disseminates cardiovascular research through its world-renowned JACC Journals, operates national registries to measure and improve care, and offers cardiovascular accreditation to hospitals and institutions. For more, visit acc.org.
The ACC’s family of JACC Journals rank among the top cardiovascular journals in the world for scientific impact. The flagship journal, the Journal of the American College of Cardiology (JACC) — and family of specialty journals consisting of JACC: Advances, JACC: Asia, JACC: Basic to Translational Science, JACC: CardioOncology, JACC: Cardiovascular Imaging, JACC: Cardiovascular Interventions, JACC: Case Reports, JACC: Clinical Electrophysiology and JACC: Heart Failure — pride themselves on publishing the top peer-reviewed research on all aspects of cardiovascular disease. Learn more at JACC.org.
JOURNAL
Journal of the American College of Cardiology
METHOD OF RESEARCH
Data/statistical analysis
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Compression-Only Versus Rescue-Breathing Cardiopulmonary Resuscitation After Pediatric Out-of-Hospital Cardiac Arrest
ARTICLE PUBLICATION DATE
7-Sep-2021
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