AHA 2016: CPR following out-of-hospital cardiac arrest improves survival in children

A registry analysis found that providing bystander cardiopulmonary resuscitation (CPR) following out-of-hospital cardiac arrest was associated with an improvement in survival and neurologically favorable survival in children younger than 18 years old.

However, bystander CPR only occurred in 46.5 percent of the out-of-hospital cardiac arrests.

Lead researcher Maryam Y. Naim, MD, of the Children’s Hospital of Philadelphia, and colleagues published their results online Nov. 12 in JAMA Pediatrics. The findings were simultaneously presented in an oral abstract session at the American Heart Association Scientific Sessions in New Orleans.

Each year, approximately 5,000 children have an out-of-hospital cardiac arrest, according to the researchers. They added that the mortality rate among these children was greater than 90 percent.

For this study, the researchers evaluated 3,900 children who were part of the Cardiac Arrest Registry to Enhance Survival (CARES) database. The Centers for Disease Control and Prevention and Emory University’s department of emergency medicine, created the CARES database, which includes data on out-of-hospital cardiac arrests from 911 call centers, responding emergency medical service professionals and receiving hospitals.

All of the children were younger than 18 and had nontraumatic out-of-hospital cardiac arrests from January 2013 through December 2015. The researchers defined nontraumatic cardiac arrest events as “apnea and unresponsiveness in which resuscitation with either CPR or defibrillation was attempted.” They did not include children who had obvious signs of death or received a “do not resuscitate” order. They also excluded arrests that occurred in medical facilities or nursing homes as well as traumatic arrests and 911 responder-witnessed arrests.

Of the children, 59.4 percent were infants, 31.3 percent were white and 60.2 percent were females. In addition, 83.7 percent of the arrests occurred at home, 72.2 percent were unwitnessed and 92.2 percent had nonshockable rhythms.

The overall survival rate was 11.3 percent, while the neurologically favorable survival rate was 9.1 percent.

The researchers found that 46.5 percent of the children received bystander CPR. A family member performed CPR in 67.4 percent of the cases, while a layperson performed CPR in 22.9 percent of the cases and a layperson with medical training performed CPR in 9.7 percent of the cases.

Bystander CPR was more common for white people and girls and in witnessed arrests, nonhome/public arrests, arrests with a shockable rhythm and arrests in which an automated external defibrillator (AED) was used.

In addition, 14.3 percent of children who received bystander CPR survived to hospital discharge compared with 8.7 percent of children who did not receive bystander CPR. A multivariable analysis found that bystander CPR was independently associated with survival to hospital discharge. Age older than 1 year, female sex, witnessed arrests, nonhome/public arrests and arrests with a shockable rhythm were other predictors of survival.

Further, 11.6 percent of children who received bystander CPR had neurologically favorable survival compared with 6.86 percent of children who did not receive bystander CPR. The multivariable analysis found that bystander CPR was independently associated with neurologically favorable survival, as well. Age older than 1 year, white race/ethnicity, witness status, arrest location, rhythm type and AED use were other predictors of survival.

The researchers also mentioned that 49.4 percent of children received conventional CPR and 50.6 percent received compression-only CPR. Both types of CPR were independently associated with survival to hospital discharge, while conventional CPR was associated with neurologically favorable survival, according to a multivariable analysis.

The study had a few limitations, according to the researchers, including that the data were observational and might have been associated with unmeasured confounding. The trial also did not include data on the quality of CPR performed, the duration of CPR or the time to CPR. In addition, the study did not include a long-term follow-up of the survivors.

“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,” the researchers wrote.