Conventional Versus Compression-Only Versus No-Bystander Cardiopulmonary Resuscitation for Pediatric Out-of-Hospital Cardiac Arrest
BACKGROUND:Conventional cardiopulmonary resuscitation (CPR) (chest compression and rescue breathing) has been recommended for pediatric out-of-hospital cardiac arrest (OHCA) because of the asphyxial nature of the majority of pediatric cardiac arrest events. However, the clinical effectiveness of add...
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| Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 2016-12, Vol.134 (25), p.2060-2070 |
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| creator | Fukuda, Tatsuma Ohashi-Fukuda, Naoko Kobayashi, Hiroaki Gunshin, Masataka Sera, Toshiki Kondo, Yutaka Yahagi, Naoki |
| description | BACKGROUND:Conventional cardiopulmonary resuscitation (CPR) (chest compression and rescue breathing) has been recommended for pediatric out-of-hospital cardiac arrest (OHCA) because of the asphyxial nature of the majority of pediatric cardiac arrest events. However, the clinical effectiveness of additional rescue breathing (conventional CPR) compared with compression-only CPR in children is uncertain.
METHODS:This nationwide population-based study of pediatric OHCA patients was based on data from the All-Japan Utstein Registry. We included all pediatric patients who experienced OHCA in Japan from January 1, 2011, to December 31, 2012. The primary outcome was a favorable neurological state 1 month after OHCA defined as a Glasgow-Pittsburgh Cerebral Performance Category score of 1 to 2 (corresponding to a Pediatric Cerebral Performance Category score of 1–3). Outcomes were compared with logistic regression with uni- and multivariable modeling in the overall cohort and for a propensity-matched subset of patients.
RESULTS:A total of 2157 patients were included; 417 received conventional CPR, 733 received compression-only CPR, and 1007 did not receive any bystander CPR. Among these patients, 213 (9.9%) survived with a favorable neurological status 1 month after OHCA, including 108/417 (25.9%) for conventional, 68/733 (9.3%) for compression-only, and 37/1007 (3.7%) for no-bystander CPR. In unadjusted analyses, conventional CPR was superior to compression-only CPR in neurologically favorable survival (odds ratio [OR] 3.42, 95% confidence interval [CI] 2.45–4.76; P |
| doi_str_mv | 10.1161/CIRCULATIONAHA.116.023831 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1843969128</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1843969128</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4221-36559e8eaa90573cb5b7781ccb72b834d97f752a5a0af2eaf67477cbbdda51473</originalsourceid><addsrcrecordid>eNqNkU9PgzAYxhujcfPPVzB481KlLaVw8IBE3ZJFjHFeSSklQwvFFlx29ovbhc3Em6emT37P--R9HwAukX-NUIhu0vlLulwkr_PsKZklW-3axyQi6ABMEcUBDCiJD8HU9_0YMoLxBJxY--6-IWH0GEwwiyJEQzIF36luv2Tb17rlynuTxg7WS3XTGWmtE2HWqs1ef9LwbmN73pbSeCk3Za27QTXOajbei3SIqHu-neVV2njPsqx5b2rhZUMPdQVn2nYOUKOXCy8xLqY_A0cVV1ae795TsHy4f01ncJE9ztNkAUWAMYIkpDSWkeQ89ikjoqAFYxESomC4iEhQxqxiFHPKfV5hyauQBYyJoihLTlHAyCm4Gud2Rn8OLjhvaiukUryVerA5igIShzHCkUPjERVGW2tklXembtyaOfLzbQf53w62Wj524LwXu5ihaGT569wf3QG3I7DWqneX_VDDWpp8JbnqV_8I-AFj1Zqs</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1843969128</pqid></control><display><type>article</type><title>Conventional Versus Compression-Only Versus No-Bystander Cardiopulmonary Resuscitation for Pediatric Out-of-Hospital Cardiac Arrest</title><source>MEDLINE</source><source>American Heart Association Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Journals@Ovid Ovid Autoload</source><creator>Fukuda, Tatsuma ; Ohashi-Fukuda, Naoko ; Kobayashi, Hiroaki ; Gunshin, Masataka ; Sera, Toshiki ; Kondo, Yutaka ; Yahagi, Naoki</creator><creatorcontrib>Fukuda, Tatsuma ; Ohashi-Fukuda, Naoko ; Kobayashi, Hiroaki ; Gunshin, Masataka ; Sera, Toshiki ; Kondo, Yutaka ; Yahagi, Naoki</creatorcontrib><description>BACKGROUND:Conventional cardiopulmonary resuscitation (CPR) (chest compression and rescue breathing) has been recommended for pediatric out-of-hospital cardiac arrest (OHCA) because of the asphyxial nature of the majority of pediatric cardiac arrest events. However, the clinical effectiveness of additional rescue breathing (conventional CPR) compared with compression-only CPR in children is uncertain.
METHODS:This nationwide population-based study of pediatric OHCA patients was based on data from the All-Japan Utstein Registry. We included all pediatric patients who experienced OHCA in Japan from January 1, 2011, to December 31, 2012. The primary outcome was a favorable neurological state 1 month after OHCA defined as a Glasgow-Pittsburgh Cerebral Performance Category score of 1 to 2 (corresponding to a Pediatric Cerebral Performance Category score of 1–3). Outcomes were compared with logistic regression with uni- and multivariable modeling in the overall cohort and for a propensity-matched subset of patients.
RESULTS:A total of 2157 patients were included; 417 received conventional CPR, 733 received compression-only CPR, and 1007 did not receive any bystander CPR. Among these patients, 213 (9.9%) survived with a favorable neurological status 1 month after OHCA, including 108/417 (25.9%) for conventional, 68/733 (9.3%) for compression-only, and 37/1007 (3.7%) for no-bystander CPR. In unadjusted analyses, conventional CPR was superior to compression-only CPR in neurologically favorable survival (odds ratio [OR] 3.42, 95% confidence interval [CI] 2.45–4.76; P<0.0001), with a trend favoring conventional CPR that was no longer statistically significant after multivariable adjustment (ORadjusted 1.52, 95% CI 0.93–2.49), and with further attenuation of the difference in a propensity-matched subset (OR 1.20, 95% CI 0.81–1.77). Both conventional and compression-only CPR were associated with higher odds for neurologically favorable survival compared with no-bystander CPR (ORadjusted 5.01, 95% CI 2.98–8.57, and ORadjusted 3.29, 95% CI 1.93–5.71), respectively.
CONCLUSIONS:In this population-based study of pediatric OHCA in Japan, both conventional and compression-only CPR were associated with superior outcomes compared with no-bystander CPR. Unadjusted outcomes with conventional CPR were superior to compression-only CPR, with the magnitude of difference attenuated and no longer statistically significant after statistical adjustments. These findings support randomized clinical trials comparing conventional versus compression-only CPR in children, with conventional CPR preferred until such controlled comparative data are available, and either method preferred over no-bystander CPR.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/CIRCULATIONAHA.116.023831</identifier><identifier>PMID: 27881563</identifier><language>eng</language><publisher>United States: by the American College of Cardiology Foundation and the American Heart Association, Inc</publisher><subject>Bystander Effect ; Cardiopulmonary Resuscitation - methods ; Child ; Databases, Factual ; Emergency Medical Services ; Female ; Humans ; Male ; Odds Ratio ; Out-of-Hospital Cardiac Arrest - mortality ; Out-of-Hospital Cardiac Arrest - therapy ; Pressure ; Registries ; Survival Rate</subject><ispartof>Circulation (New York, N.Y.), 2016-12, Vol.134 (25), p.2060-2070</ispartof><rights>2016 by the American College of Cardiology Foundation and the American Heart Association, Inc.</rights><rights>2016 American Heart Association, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4221-36559e8eaa90573cb5b7781ccb72b834d97f752a5a0af2eaf67477cbbdda51473</citedby><cites>FETCH-LOGICAL-c4221-36559e8eaa90573cb5b7781ccb72b834d97f752a5a0af2eaf67477cbbdda51473</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,3674,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27881563$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fukuda, Tatsuma</creatorcontrib><creatorcontrib>Ohashi-Fukuda, Naoko</creatorcontrib><creatorcontrib>Kobayashi, Hiroaki</creatorcontrib><creatorcontrib>Gunshin, Masataka</creatorcontrib><creatorcontrib>Sera, Toshiki</creatorcontrib><creatorcontrib>Kondo, Yutaka</creatorcontrib><creatorcontrib>Yahagi, Naoki</creatorcontrib><title>Conventional Versus Compression-Only Versus No-Bystander Cardiopulmonary Resuscitation for Pediatric Out-of-Hospital Cardiac Arrest</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>BACKGROUND:Conventional cardiopulmonary resuscitation (CPR) (chest compression and rescue breathing) has been recommended for pediatric out-of-hospital cardiac arrest (OHCA) because of the asphyxial nature of the majority of pediatric cardiac arrest events. However, the clinical effectiveness of additional rescue breathing (conventional CPR) compared with compression-only CPR in children is uncertain.
METHODS:This nationwide population-based study of pediatric OHCA patients was based on data from the All-Japan Utstein Registry. We included all pediatric patients who experienced OHCA in Japan from January 1, 2011, to December 31, 2012. The primary outcome was a favorable neurological state 1 month after OHCA defined as a Glasgow-Pittsburgh Cerebral Performance Category score of 1 to 2 (corresponding to a Pediatric Cerebral Performance Category score of 1–3). Outcomes were compared with logistic regression with uni- and multivariable modeling in the overall cohort and for a propensity-matched subset of patients.
RESULTS:A total of 2157 patients were included; 417 received conventional CPR, 733 received compression-only CPR, and 1007 did not receive any bystander CPR. Among these patients, 213 (9.9%) survived with a favorable neurological status 1 month after OHCA, including 108/417 (25.9%) for conventional, 68/733 (9.3%) for compression-only, and 37/1007 (3.7%) for no-bystander CPR. In unadjusted analyses, conventional CPR was superior to compression-only CPR in neurologically favorable survival (odds ratio [OR] 3.42, 95% confidence interval [CI] 2.45–4.76; P<0.0001), with a trend favoring conventional CPR that was no longer statistically significant after multivariable adjustment (ORadjusted 1.52, 95% CI 0.93–2.49), and with further attenuation of the difference in a propensity-matched subset (OR 1.20, 95% CI 0.81–1.77). Both conventional and compression-only CPR were associated with higher odds for neurologically favorable survival compared with no-bystander CPR (ORadjusted 5.01, 95% CI 2.98–8.57, and ORadjusted 3.29, 95% CI 1.93–5.71), respectively.
CONCLUSIONS:In this population-based study of pediatric OHCA in Japan, both conventional and compression-only CPR were associated with superior outcomes compared with no-bystander CPR. Unadjusted outcomes with conventional CPR were superior to compression-only CPR, with the magnitude of difference attenuated and no longer statistically significant after statistical adjustments. These findings support randomized clinical trials comparing conventional versus compression-only CPR in children, with conventional CPR preferred until such controlled comparative data are available, and either method preferred over no-bystander CPR.</description><subject>Bystander Effect</subject><subject>Cardiopulmonary Resuscitation - methods</subject><subject>Child</subject><subject>Databases, Factual</subject><subject>Emergency Medical Services</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Odds Ratio</subject><subject>Out-of-Hospital Cardiac Arrest - mortality</subject><subject>Out-of-Hospital Cardiac Arrest - therapy</subject><subject>Pressure</subject><subject>Registries</subject><subject>Survival Rate</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkU9PgzAYxhujcfPPVzB481KlLaVw8IBE3ZJFjHFeSSklQwvFFlx29ovbhc3Em6emT37P--R9HwAukX-NUIhu0vlLulwkr_PsKZklW-3axyQi6ABMEcUBDCiJD8HU9_0YMoLxBJxY--6-IWH0GEwwiyJEQzIF36luv2Tb17rlynuTxg7WS3XTGWmtE2HWqs1ef9LwbmN73pbSeCk3Za27QTXOajbei3SIqHu-neVV2njPsqx5b2rhZUMPdQVn2nYOUKOXCy8xLqY_A0cVV1ae795TsHy4f01ncJE9ztNkAUWAMYIkpDSWkeQ89ikjoqAFYxESomC4iEhQxqxiFHPKfV5hyauQBYyJoihLTlHAyCm4Gud2Rn8OLjhvaiukUryVerA5igIShzHCkUPjERVGW2tklXembtyaOfLzbQf53w62Wj524LwXu5ihaGT569wf3QG3I7DWqneX_VDDWpp8JbnqV_8I-AFj1Zqs</recordid><startdate>20161220</startdate><enddate>20161220</enddate><creator>Fukuda, Tatsuma</creator><creator>Ohashi-Fukuda, Naoko</creator><creator>Kobayashi, Hiroaki</creator><creator>Gunshin, Masataka</creator><creator>Sera, Toshiki</creator><creator>Kondo, Yutaka</creator><creator>Yahagi, Naoki</creator><general>by the American College of Cardiology Foundation and the American Heart Association, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20161220</creationdate><title>Conventional Versus Compression-Only Versus No-Bystander Cardiopulmonary Resuscitation for Pediatric Out-of-Hospital Cardiac Arrest</title><author>Fukuda, Tatsuma ; Ohashi-Fukuda, Naoko ; Kobayashi, Hiroaki ; Gunshin, Masataka ; Sera, Toshiki ; Kondo, Yutaka ; Yahagi, Naoki</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4221-36559e8eaa90573cb5b7781ccb72b834d97f752a5a0af2eaf67477cbbdda51473</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Bystander Effect</topic><topic>Cardiopulmonary Resuscitation - methods</topic><topic>Child</topic><topic>Databases, Factual</topic><topic>Emergency Medical Services</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Odds Ratio</topic><topic>Out-of-Hospital Cardiac Arrest - mortality</topic><topic>Out-of-Hospital Cardiac Arrest - therapy</topic><topic>Pressure</topic><topic>Registries</topic><topic>Survival Rate</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fukuda, Tatsuma</creatorcontrib><creatorcontrib>Ohashi-Fukuda, Naoko</creatorcontrib><creatorcontrib>Kobayashi, Hiroaki</creatorcontrib><creatorcontrib>Gunshin, Masataka</creatorcontrib><creatorcontrib>Sera, Toshiki</creatorcontrib><creatorcontrib>Kondo, Yutaka</creatorcontrib><creatorcontrib>Yahagi, Naoki</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fukuda, Tatsuma</au><au>Ohashi-Fukuda, Naoko</au><au>Kobayashi, Hiroaki</au><au>Gunshin, Masataka</au><au>Sera, Toshiki</au><au>Kondo, Yutaka</au><au>Yahagi, Naoki</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Conventional Versus Compression-Only Versus No-Bystander Cardiopulmonary Resuscitation for Pediatric Out-of-Hospital Cardiac Arrest</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>2016-12-20</date><risdate>2016</risdate><volume>134</volume><issue>25</issue><spage>2060</spage><epage>2070</epage><pages>2060-2070</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><abstract>BACKGROUND:Conventional cardiopulmonary resuscitation (CPR) (chest compression and rescue breathing) has been recommended for pediatric out-of-hospital cardiac arrest (OHCA) because of the asphyxial nature of the majority of pediatric cardiac arrest events. However, the clinical effectiveness of additional rescue breathing (conventional CPR) compared with compression-only CPR in children is uncertain.
METHODS:This nationwide population-based study of pediatric OHCA patients was based on data from the All-Japan Utstein Registry. We included all pediatric patients who experienced OHCA in Japan from January 1, 2011, to December 31, 2012. The primary outcome was a favorable neurological state 1 month after OHCA defined as a Glasgow-Pittsburgh Cerebral Performance Category score of 1 to 2 (corresponding to a Pediatric Cerebral Performance Category score of 1–3). Outcomes were compared with logistic regression with uni- and multivariable modeling in the overall cohort and for a propensity-matched subset of patients.
RESULTS:A total of 2157 patients were included; 417 received conventional CPR, 733 received compression-only CPR, and 1007 did not receive any bystander CPR. Among these patients, 213 (9.9%) survived with a favorable neurological status 1 month after OHCA, including 108/417 (25.9%) for conventional, 68/733 (9.3%) for compression-only, and 37/1007 (3.7%) for no-bystander CPR. In unadjusted analyses, conventional CPR was superior to compression-only CPR in neurologically favorable survival (odds ratio [OR] 3.42, 95% confidence interval [CI] 2.45–4.76; P<0.0001), with a trend favoring conventional CPR that was no longer statistically significant after multivariable adjustment (ORadjusted 1.52, 95% CI 0.93–2.49), and with further attenuation of the difference in a propensity-matched subset (OR 1.20, 95% CI 0.81–1.77). Both conventional and compression-only CPR were associated with higher odds for neurologically favorable survival compared with no-bystander CPR (ORadjusted 5.01, 95% CI 2.98–8.57, and ORadjusted 3.29, 95% CI 1.93–5.71), respectively.
CONCLUSIONS:In this population-based study of pediatric OHCA in Japan, both conventional and compression-only CPR were associated with superior outcomes compared with no-bystander CPR. Unadjusted outcomes with conventional CPR were superior to compression-only CPR, with the magnitude of difference attenuated and no longer statistically significant after statistical adjustments. These findings support randomized clinical trials comparing conventional versus compression-only CPR in children, with conventional CPR preferred until such controlled comparative data are available, and either method preferred over no-bystander CPR.</abstract><cop>United States</cop><pub>by the American College of Cardiology Foundation and the American Heart Association, Inc</pub><pmid>27881563</pmid><doi>10.1161/CIRCULATIONAHA.116.023831</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; American Heart Association Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Journals@Ovid Ovid Autoload |
| subjects | Bystander Effect Cardiopulmonary Resuscitation - methods Child Databases, Factual Emergency Medical Services Female Humans Male Odds Ratio Out-of-Hospital Cardiac Arrest - mortality Out-of-Hospital Cardiac Arrest - therapy Pressure Registries Survival Rate |
| title | Conventional Versus Compression-Only Versus No-Bystander Cardiopulmonary Resuscitation for Pediatric Out-of-Hospital Cardiac Arrest |
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