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March 03, 2010
Filed Under (Cardiovascular / Cardiology, Pediatrics / Children's Health) by Aashi
A study published Online First reports that cardiopulmonary resuscitation (CPR) by bystanders increases the likelihood of survival for children who have cardiac arrests outside of a hospital. In addition, CPR that includes chest compressions with rescue breathing is more important for non-cardiac causes of cardiac arrest, such as drowning, than chest compressions alone. The study is the work of Dr Taku Iwami, Kyoto University Health Service, Kyoto, Japan, and colleagues. CPR has been shown to improve survival rates. The American Heart Association recommends CPR by bystanders with chest compression only for adults who have cardiac arrests outside of a hospital. But, such an association for children has not been confirmed because the majority of earlier studies have not had a sufficient sample size. This population-based cohort study was nationwide. The researchers enrolled 5,170 children aged 17 years or younger who had had a cardiac arrest outside of a hospital. Data were obtained on whether or not the children had been given CPR, and if so, whether or not it was compression-only CPR or CPR with rescue breathing. The primary endpoint was a favorable neurological outcome at one month after the cardiac arrest. This was defined by a Glasgow-Pittsburgh cerebral performance category of: • 1 :good performance Results indicate that a favorable neurological outcome was about three times more likely for children who had been given any CPR by a bystander than for those who had not. Conventional CPR with rescue breathing in children whose cardiac arrests had a non-cardiac cause was more likely to improve survival than compression-only CPR. Both types of CPR had similar effect for children whose arrests were cardiac in cause. The authors remark: “Unlike previous studies that were underpowered to show this important association, our study is sufficiently large to identify the important beneficial effect of bystander CPR on survival outcomes after paediatric cardiac arrest.” They write in conclusion: “Our data lead us to lend support to a double CPR training strategy: compression-only CPR training for most people to increase bystander CPR by bystanders, and conventional CPR (chest compression plus rescue breathing) training for individuals who are most likely to witness children who have cardiac arrests with non-cardiac causes, such as medical professionals, lifeguards, school teachers, families with children, and families with swimming pools.” In an associated note, Dr Jesús López-Herce and Dr Angel Carrillo Alvarez, Pediatric Intensive Care Service, Hospital General Universitario Gregorio, Madrid, Spain, comment that this study “confirms that early bystander-initiated CPR is one of the fundamental factors to improve prognosis, in adults and children.” They mention that Iwami et al’s information: “underline the importance of not extrapolating findings from adults to children, because cardiac arrest in children has specific characteristics. In adults, 65% of out-of-hospital cardiac arrests are of cardiac origin, whereas in children at least 71% are of non-cardiac origin. 71% is probably an underestimate because the diagnosis of cardiac origin was by exclusion in today’s study and, in other studies, cardiac causes accounted for less than 10% of cases.” They say in closing: “Chest compression plus ventilation should continue to be the standard, a technique that should be taught to the whole population.” “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” Related posts:
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