Association between the types of bystander cardiopulmonary resuscitation and the survival with good neurologic outcome of preschool pediatric out-of-hospital cardiac arrest cases in Japan: A propensity score matching analysis using an extended nationwide database

Abstract

BackgroundPediatric out-of-hospital cardiac arrests (OHCAs) are frequently associated with a respiratory etiology. Despite the high proportion of preschool children with OHCAs, very few studies on this special population exist. This study characterizes the epidemiologic features of preschool pediatric OHCAs and analyzes the advantage of conventional (ventilations with chest compressions) bystander cardiopulmonary resuscitation (CPR) over compression-only bystander CPR (BCPR) on the one-month post-event neurological status of the patient.MethodsJapanese nationwide databases for all ambulance transport events and OHCAs occurring during a 4-year period between 2016 and 2019 were combined, totalling 3,608 patient events. Children ≤6-years-old were included; physician- and EMS-witnessed events, no prehospital resuscitation effort events, and neonatal patient events were excluded. Neurologically favorable 1-month survival rates were compared among groups using univariate and multivariate analyses before and after propensity score matching.ResultsFrom the combined database, 2,882 pediatric OHCAs meeting selection criteria were categorized as no BCPR (984), compression-only BCPR (1,428), and conventional BCPR (470). The proportion of bystander-witnessed cases was low (22.3%). Most OHCA witnesses were family members (88.5%), and most OHCAs occurred at home (88.0%). The neurologically favorable 1-month survival rates were: no BCPR 2.4%, compression only, 3.2%, and conventional 6.6% (P < 0.01). Multivariate logistic regression analysis before and after matching showed that conventional BCPR was associated with higher neurologically favorable 1-month survival than compression-only BCPR. Subgroup analyses after matching demonstrated that conventional BCPR was associated with better outcomes in nonmedical (adjusted odds ratio; 95% confidence interval, 2.83; 1.09–7.32) and unwitnessed OHCA cases (3.42; 1.09–10.8).ConclusionsConventional CPR is rarely performed by bystanders in preschool pediatric OHCA. However, conventional BCPR results in neurologically favorable outcomes in nonmedical and unwitnessed cases.

Out-of-hospital cardiac arrest in children: an epidemiological study based on the German Resuscitation Registry identifying modifiable factors for return of spontaneous circulation

“…The importance of bystander ventilation and chest compression was found by a previous study, indicating that the results are likely to apply to both children and adults [26]. This points out the relevance of bystander-initiated ventilation in children suffering from OHCA even if survival to hospital discharge has not yet improved [27,28].…”

Impact of 2020 COVID-19 pandemic on bystander reaction to and outcomes of pediatric out-of-hospital cardiac arrest in Japan: a population-based, nationwide cohort study

“…Neurologically favorable outcomes did not improve in patients with unwitnessed OHCA. Patients with unwitnessed OHCA have already developed hypoxemia, and early ventilation was required [24]. Furthermore, the shift to compression-only BCPR, which might be accelerated during the pandemic, might explain the lack of neurologically favorable outcome improvement for temporary school closure days and OHCA in childcare and education facilities, where the proportion of compression-only BCPR was markedly increased.…”

Out-of-hospital cardiac arrest in children: An epidemiological study based on the German Resuscitation Registry identifying modifiable factors for return of spontaneous circulation

“…Con dence intervals of CCO and CCV for hospital admission with ROSC barely overlap, indicating a possible signi cant difference in favour of CCV [23]. To conclude, this points out the relevance of bystander-initiated ventilation in children suffering from OHCA even if survival to hospital discharge has not yet improved [24,25]. One confounder might be that bystanders who perform CCV are better trained and provide more su cient CPR than those who provide chest compressions "only".…”