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2017 Evidence Summary

A large observational study from the All-Japan Utstein Registry1 compared bystander-administered chest compression–only CPR and CPR using chest compressions with rescue breaths from 2005 through 2007, a period when guidelines transitioned from a compression-to-ventilation ratio of 15:2 to 30:2 for postpubertal children and adults. Favorable neurologic outcome and survival at 1 month was observed less frequently with chest compression–only CPR. When the results were stratified by age, children 1 through 17 years of age had worse outcomes with chest compression–only CPR, whereas no statistical difference between chest compression–only CPR and CPR using chest compressions with rescue breaths was observed in infants < 1 year of age. When further stratified by arrest cardiac cause, there was no difference between chest compression–only CPR and CPR using chest compressions with rescue breaths in patients with a presumed cardiac cause.

A subsequent study examined dispatch-assisted CPR in children using the same national Japanese database but with a later time interval, 2008 through 2010.2 CPR using chest compressions with rescue breaths was generally offered by dispatchers, but chest compression–only CPR could be offered depending on the skill and knowledge of the rescuer.

Chest compression–only CPR resulted in worse 1-month survival and worse 1-month survival with favorable neurologic outcome compared with CPR using chest compressions with rescue breaths. Chest compression–only CPR was no different from no CPR.

A large observational study from the US-based Cardiac Arrest Registry to Enhance Survival (CARES) evaluated the association of bystander CPR with overall and favorable neurologic survival. The CARES registry is an emergency medical services–based, voluntary data set that includes a catchment area of 90 million people from 37 states within the United States. The authors compared bystander-administered chest compression–only CPR to CPR using chest compressions with rescue breaths.3 The cohort was analyzed based on age: < 1 or 1 to 18 years. For infants, CPR using chest compressions with rescue breaths was better than no CPR but was no different from chest compression–only CPR for favorable neurologic outcome. CPR using chest compressions with rescue breaths had higher survival to discharge than either no CPR or chest compression–only CPR. For children 1 to 18 years of age, CPR using chest compressions with rescue breaths was better than no CPR but was no different from chest compression–only CPR for both survival to hospital discharge and favorable neurological status. Of note, outcomes were statistically better in both bystander CPR strategies compared with no bystander CPR, as opposed to the Kitamura et al1 and Goto et al2 reports.

The most recent study originated from Japan with the use of the All-Japan Utstein Registry. The authors directly compared bystander chest compression–only CPR and CPR using chest compressions with rescue breaths in children >1 year of age who had cardiac arrest, including traumatic arrest, during 2011 and 2012.4 A national dispatch-assisted instruction protocol was in use, and CPR guidelines recommended a compression-to-ventilation ratio of 30:2. Chest compression–only CPR and CPR using chest compressions with rescue breaths were associated with improved survival at 1 month and favorable neurologic survival at 1 month compared with no bystander CPR. There was no difference between chest compression–only CPR and CPR using chest compressions with rescue breaths.

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References

  1. Kitamura T, Iwami T, Kawamura T, Nagao K, Tanaka H, Nadkarni VM, Berg RA, Hiraide A; for the Implementation Working Group for All-Japan Utstein Registry of the Fire and Disaster Management Agency. Conventional and chest-compression-only cardiopulmonary resuscitation by bystanders for children who have out-of-hospital cardiac arrests: a prospective, nationwide, population-based cohort study. Lancet. 2010;375:1347–1354. doi: 10.1016/s0140-6736(10)60064-5.
  2. Goto Y, Maeda T, Goto Y. Impact of dispatcher-assisted bystander cardiopulmonary resuscitation on neurological outcomes in children with out-of-hospital cardiac arrests: a prospective, nationwide, population-based cohort study. J Am Heart Assoc. 2014;3:e000499. doi: 10.1161/jaha.113.000499.
  3. Naim MY, Burke RV, McNally BF, Song L, Griffis HM, Berg RA, Vellano K, Markenson D, Bradley RN, Rossano JW. Association of bystander cardiopulmonary resuscitation with overall and neurologically favorable survival after pediatric out-of-hospital cardiac arrest in the United States: a report from the Cardiac Arrest Registry to Enhance Survival Surveillance Registry. JAMA Pediatr. 2017;171:133–141. doi: 10.1001/jamapediatrics.2016.3643.
  4. Fukuda T, Ohashi-Fukuda N, Kobayashi H, Gunshin M, Sera T, Kondo Y, Yahagi N. Conventional versus compression-only versus no-bystander cardiopulmonary resuscitation for pediatric out-of-hospital cardiac arrest. Circulation. 2016;134:2060–2070. doi: 10.1161/circulationaha.116.023831.
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2017 Evidence Summary

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