Compression-Only Versus Rescue-Breathing Cardiopulmonary Resuscitation After Pediatric Out-of-Hospital Cardiac...

Area of Science:

• Emergency Medicine
• Pediatric Resuscitation
• Cardiovascular Research

Background:

• Conflicting data exist on the efficacy of compression-only cardiopulmonary resuscitation (CO-CPR) versus cardiopulmonary resuscitation with rescue breathing (RB-CPR) in pediatric out-of-hospital cardiac arrest (OHCA).
• Understanding the optimal bystander CPR strategy is crucial for improving survival rates in pediatric OHCA.

Purpose of the Study:

• To evaluate if RB-CPR is associated with improved neurologically favorable survival compared to CO-CPR in pediatric OHCA.
• To analyze age-stratified outcomes based on CPR type (RB-CPR, CO-CPR, or no bystander CPR [NO-CPR]).

Main Methods:

• Analysis of the Cardiac Arrest Registry to Enhance Survival (CARES) database for nontraumatic pediatric OHCAs (≤18 years) from 2013-2019.
• Stratification of patients into infants (<1 year), children (1-11 years), and adolescents (≥12 years).
• Primary outcome was neurologically favorable survival at hospital discharge.

Main Results:

• RB-CPR was associated with significantly higher neurologically favorable survival compared to CO-CPR (adjusted OR: 1.36).
• Both RB-CPR and CO-CPR were associated with improved survival compared to NO-CPR.
• RB-CPR demonstrated better survival outcomes across all age groups, while CO-CPR showed benefit only in children and adolescents, not infants.

Conclusions:

• RB-CPR is associated with superior neurologically favorable survival outcomes compared to CO-CPR in pediatric OHCA.
• These findings support current guidelines recommending RB-CPR as the preferred resuscitation method for pediatric OHCA.
• Age-specific considerations may be necessary when evaluating CO-CPR effectiveness in infants.