NEW ORLEANS — In children with out-of-hospital cardiac arrest, bystander CPR conferred a survival benefit, but conventional bystander CPR was associated with better outcomes than compression-only bystander CPR, according to findings presented at the American Heart Association Scientific Sessions.
Researchers analyzed data from the CARES database of 3,900 children aged younger than 18 years who had nontraumatic out-of-hospital cardiac arrest between 2013 and 2015. Of those, 59.4% were infants, 60.2% were females and 92.2% had nonshockable rhythms.
The main outcomes of interest were overall survival and neurologically favorable survival, defined as Cerebral Performance Category score 1 or 2 at discharge. Patients were stratified by race, by whether they had bystander CPR and by what type of bystander CPR was performed (conventional or compression-only).
Bystander CPR was performed on 46.5% of the cohort and was more common in white children (56.3%) than in black children (39.4%) or Hispanic children (43.3%; P < .001), Maryam Y. Naim, MD, from the cardiac center at The Children’s Hospital of Philadelphia, Perelman School of Medicine, The University of Pennsylvania, and colleagues reported.
Maryam Y. Naim
In the entire cohort, overall survival was 11.3% and neurologically favorable survival was 9.1%.
When Naim and colleagues conducted a multivariable analysis, bystander CPR was associated with better survival (adjusted proportion, 13.2%; 95% CI, 11.81-14.58; adjusted OR = 1.57; 95% CI, 1.25-1.96) and favorable neurological survival (adjusted proportion, 10.3%; 95% CI, 9.1-11.54; adjusted OR = 1.5; 95% CI, 1.21-1.98).
For those who did not receive bystander CPR, the adjusted rate of overall survival was 9.5% (95% CI, 8.28-10.69) and the adjusted rate of neurologically favorable survival was 7.59%; 95% CI, 6.5-8.68).
Among those for whom data on type of CPR were available, 49.4% received conventional CPR and 50.6% received compression-only CPR.
Conventional CPR was associated with neurologically favorable survival compared with no CPR (adjusted proportion for conventional CPR, 12.89%; 95% CI, 10.69-15.09; adjusted proportion for no CPR, 9.59; 95% CI, 6.45-8.61; adjusted OR = 2.06; 95% CI, 1.51-2.79), according to results of the multivariable analysis.
For infants, conventional CPR, compared with no CPR, was associated with a higher rate of the survival outcomes, but the same association was not observed with compression-only CPR. For children aged 1 to 18 years, both types of CPR were associated with better outcomes compared with no CPR, Naim and colleagues reported.
“There are several important findings; the first is that compression-only CPR occurs as frequently as conventional CPR in children who have an out-of-hospital cardiac arrest,” Naim told Cardiology Today. “There is a racial disparity in the type of bystander CPR provided to children; white children are more likely to receive conventional CPR whereas black and Hispanic children are more likely to receive compression-only CPR. In infants — children less than the age of 1, which is the largest age group to have a cardiac arrest — compression-only CPR outcomes were similar to no bystander CPR provision and only conventional CPR was associated with improved outcomes. Although both types of CPR are associated with survival to hospital discharge compared to no bystander CPR, only conventional CPR is associated with favorable neurologic outcome.“
The data were simultaneously published in JAMA Pediatrics.
Naim said in an interview that the study “suggests that public health efforts need to be undertaken to improve conventional CPR provision in children, which may lead to improved outcomes. These efforts are especially needed in minority communities.”
In a related editorial in JAMA Pediatrics, Sarah E. Haskell, DO, and Dianne L. Atkins, MD, noted that the new data from Naim and colleagues support current AHA recommendations that either type of CPR should be given to children with out-of-hospital cardiac arrest, except for infants, who should receive conventional CPR.
“A major problem in bystander CPR is the racial disparity that exists in some populations,” Haskell and Atkins, both from the department of pediatrics at University of Iowa Children’s Hospital and University of Iowa Carver College of Medicine, Iowa City, wrote. “Given the improvement in outcomes in children with [out-of-hospital cardiac arrest] that received bystander CPR, this is an important public health concern that needs to be addressed.”
The presentation received an award for Best Abstract: Resuscitation. – by Erik Swain
Naim MY, et al. Presentation 20. Presented at: American Heart Association Scientific Sessions; Nov. 12-16, 2016; New Orleans.
Haskell SE, Atkins DL. JAMA Pediatr. 2016;doi:10.1001/jamapediatrics.2016.3694.
Naim MY, et al. JAMA Pediatr. 2016;doi:10.1001/jamapediatrics.2016.3643.
Disclosure: Atkins, Haskell and Naim report no relevant financial disclosures.