Lancet: For children with cardiac arrest, conventional CPR is best

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Currently, cardiopulmonary resuscitation (CPR) with compression is not recommended to be performed by bystanders on children. However, researchers have found for children who have out-of-hospital cardiac arrest from non-cardiac causes, CPR (with rescue breathing) by a bystander is the preferable approach to resuscitation, and for pediatric arrests from cardiac causes, either conventional or compression-only CPR is similarly effective, based on a study in the April 17 issue of the Lancet.

Tetsuhisa Kitamura, MD, of Kyoto University Health Service, along with colleagues from the implementation working group for All-Japan Utstein Registry of the Fire and Disaster Management Agency, studied the effect of CPR by assessing neurological outcomes one-month after out-of hospital cardiac arrest in a pediatric population.

According to the authors, the American Heart Association supports CPR by bystanders with chest compression in adult patients indicating cardiac arrest, but not children.

The researchers evaluated 5,170 children, aged 17 years or younger, from Jan.1, 2005, to Dec.31, 2007, who experienced out-of-hospital cardiac arrest. Kitamura et al found that of the patients, 71 percent had arrests due to non-cardiac causes while 29 percent were related to cardiac causes.

To remedy cardiac-arrest, 30 percent (1,551 patients) received conventional CPR while 17 percent (888 patients) received compression-only CPR.

According to the results, those pediatric patients who underwent CPR by a bystander had significantly higher rates of neurological outcomes than those who were not given CPR, 4.5 percent versus 1.9 percent, respectively.

Additionally, children between the ages of 1 to 17 who experienced cardiac arrest due to non-cardiac causes showed more favorable neurological outcomes after receiving CPR by a bystander compared to those who received no CPR, 5.1 versus 1.5 percent, respectively.

For children aged 1 to 17 who experienced cardiac arrest due to cardiac causes, neurological function was more promising in those who received CPR from a bystander than those who did not—9.5 versus 4.1 percent.

The researchers found, however, that results for infants were poor no matter what the circumstance.

In contrast, results showed that those who underwent compression-only CPR had poorer neurological results than those who received conventional CPR, 1.6 versus 7.2 percent, respectively.

The study was funded by the Ministry of Education, Culture, Sports, Science and Technology and the Fire and Disaster Management Agency, both in Japan.