1017 Frequency and effectiveness of bystander resuscitation for out-of-hospital cardiac arrest

A number of interesting statistics can be found in a recent Lancet article covering outcomes after out-of-hospital cardiac arrest in children of up to 17 years of age. Firstly, in Japan, a country of 121 million people, the prospective study was done using data from the registry of the Fire and Disaster Management Agency, a registry that captures all out-of-hospital arrests in adults and children. The second is that 1.4 million Japanese are trained in CPR each year. In terms of the latter, there is discussion around the issue of teaching compression-only vs compression plus rescue breathing – this because the majority (around two-thirds) of adult arrests are of cardiac origin and there are international data showing the superiority or non-inferiority of compression-only CPR in adults with this form of arrest. In contrast, in children the majority of arrests are non-cardiac. In this Japanese report, data were reviewed for 5758 documented arrests, an overall rate of 8/100 000 person years. Notably the overall rate for infants <1 year of age was much higher at 65.9/100 000 person years, with the presumed cardiac cause rate at 22.6/100 000 and non-cardiac at 43.3/100 000. Analysis was possible for 5170 children, with just over one-quarter of arrests witnessed by bystanders who intervened. Overall survival was low at 9%, and only 3% of the study population had a good neurological outcome. Survival and neurological outcome were better for those who received bystander resuscitation than for the ones who did not. For arrest of non-cardiac origin the results were better with compression-only CPR, whereas in the cardiac-origin group outcomes were not related to the type of resuscitation. The latter results relate to the whole group whereas in infants outcomes were uniformly poor, likely because cases such as those with SIDS would have been beyond resuscitation by the time they are found. These results suggest that CPR programmes should not universally switch to teaching compression-only resuscitation since this would reduce chances of success in children who are twice as likely as adults to experience non-cardiac reasons for an arrest.

Read more:
Lancet 2010; 375: 1321-2 and 1347-54
Circulation 2008; 117: 2162-7
Pediatr Emerg Care 2005; 12 807-15