Abstract 19: Cardiopulmonary Resuscitation by Bystanders with Chest Compressions Only for Children with Witnessed Out-of-Hospital Cardiac Arrest

Abstract

Background: Conventional cardiopulmonary resuscitation (CPR) is a barrier to bystanders including parents doing CPR for children. Particularly mouth-to-mouth ventilation has been considered to be difficult to teach and perform. Several clinical studies have shown the efficacy of bystander CPR by chest compression only (CC-only) for adults, but not yet stated enough for children. Methods: In a nationwide out-of-hospital cardiac arrest (OHCA) registration from 2005 to 2010, we enrolled 11,417 children aged less than 18 years old. Data collected include age, etiology, ECG wave form, type of CPR, and neurological outcome. Favorable outcome was defined as cerebral performance category 1 or 2. Results: 3,486 (31%) children with OHCA were described as cardiac etiology, and 7,931 (69%) as non-cardiac. VF/pulseless VT (VF/pVT) in 546 (5%) cases, PEA in 1,668 (15%), and asystole in 8,168 (71%). 3,041 (27%) cases received conventional CPR, 2,421 (21%) received CC-only CPR, and 5,507 (48%) were given no CPR. Within 2,808 (25%) children with witnessed citizen bystanders, 706 (25% of 2,808) received conventional CPR and 577 (21% of 2,808) received CC-only CPR, but outcome was not available in 69 cases. Any CPR comparing with no CPR (8.5% [463/5,462] vs 3.1% [168/5,507]; OR 2.78, 2.32-3.32), or conventional CPR comparing with CC-only (11% [329/3,041] vs 5.5% [134/2,421]; OR 1.95, 1.59-2.40) showed higher favorable outcomes. However, analysis in children with witnessed citizen bystanders revealed no difference on favorable outcome between conventional CPR and CC-only CPR (9.0% [60/668] vs 7.5% [41/546]; OR 1.22, 0.80-1.83). In each waveform group (VF/pVT; 32% [38/118] vs 29% [25/86]; OR 1.11, 0.62-1.97, PEA 7.1% [11/156] vs 6.3% [9/142]; OR 1.11, 0.45-2.76, Asystole 3.1% [11/353] vs 2.2% [7/318]; OR 1.42, 0.54-3.69), even excluding infants (11% [56/514] vs 8.0% [35/438]; OR 1.36, 0.88-2.11), indicated same trends. Conclusion: CC-only CPR by witnessed citizen is equally effective for children who have witnessed OHCA, comparing with conventional CPR. Enhancement of citizen bystander CPR including children with uniform BLS algorithm is reasonable, and need to be enriched further to diminish paediatric OHCA events without bystander CPR.