Conventional versus chest-compression-only cardiopulmonary resuscitation by bystanders for children with out-of-hospital cardiac arrest.

Abstract

It is unclear whether chest-compression-only cardiopulmonary resuscitation (CC-CPR) is therapeutically equivalent to conventional CPR for children with out-of-hospital cardiac arrest (OHCA). We aimed to determine the association of CC-CPR and conventional CPR with outcomes in discrete child patient populations with OHCA. We analysed 6810 children (aged <18years) using Japanese registry from 2007 to 2014. Main outcomes measure was 30-day neurologically intact survival after OHCA, defined as Glasgow-Pittsburgh cerebral performance categories 1 or 2. In propensity score-matched children aged 1-17 years (n=2682), overall neurologically intact survival rate was significantly higher after conventional CPR than after CC-CPR (9.4% vs. 6.0%, P=0.001). However, there was no significant difference between the two CPR modalities in patients with cardiac aetiology (14.2% vs. 11.8%, P=0.32), initial shockable rhythm (35.3% vs. 31.7%, P=0.59), or age ≥8 years (12.4% vs. 9.8%, P=0.13). For matched infants (n=1994), no significant differences were observed in overall neurological intact survival between conventional CPR and CC-CPR (2.2% vs. 1.3%, P=0.17). In infant subgroup analyses, neurologically intact survival was similar between the CPR modalities for cardiac aetiology (0.3% vs. 1.0%; P=0.37) and for witnessed arrest (6.2% vs. 6.0%; P=0.98). In the majority of the paediatric subgroups, conventional CPR was associated with improved outcomes compared to CC-CPR. CC-CPR was associated with 30-day neurologically intact survival similar to conventional CPR for children with OHCA aged ≥8 years, for children aged 1-17 years with cardiac aetiology or initial shockable rhythm, and for infants with cardiac aetiology or witnessed arrest.