title: Association of Bystander Cardiopulmonary Resuscitation With Overall and Neurologically Favorable Survival After Pediatric Out-of-Hospital Cardiac Arrest in the United States: A Report From the Cardiac Arrest Registry to Enhance Survival Surveillance Registry.
abstract: There are few data on the prevalence or outcome of bystander cardiopulmonary resuscitation (BCPR) in children 18 years and younger.
  
  
  
  To characterize BCPR in pediatric out-of-hospital cardiac arrests (OHCAs).
  
  
  
  This analysis of the Cardiac Arrest Registry to Enhance Survival database investigated nontraumatic OHCAs in children 18 years and younger from January 2013 through December 2015.
  
  
  
  Bystander CPR, which included conventional CPR and compression-only CPR.
  
  
  
  Overall survival and neurologically favorable survival, defined as a Cerebral Performance Category score of 1 or 2, at the time of hospital discharge.
  
  
  
  Of the 3900 children younger than 18 years with OHCA, 2317 (59.4%) were infants, 2346 (60.2%) were female, and 3595 (92.2%) had nonshockable rhythms. Bystander CPR was performed on 1814 children (46.5%) and was more common for white children (687 of 1221 [56.3%]) compared with African American children (447 of 1134 [39.4%]) and Hispanic children (197 of 455 [43.3%]) (P < .001). Overall survival and neurologically favorable survival were 11.3% (440 of 3900) and 9.1% (354 of 3900), respectively. On multivariable analysis, BCPR was independently associated with improved overall survival (adjusted proportion, 13.2%; 95% CI, 11.81-14.58; adjusted odds ratio, 1.57; 95% CI, 1.25-1.96) and neurologically favorable survival (adjusted proportion, 10.3%; 95% CI, 9.10-11.54; adjusted odds ratio, 1.50; 95% CI, 1.21-1.98) compared with no BCPR (overall survival: adjusted proportion, 9.5%; 95% CI, 8.28-10.69; neurologically favorable survival: adjusted proportion, 7.59%; 95% CI, 6.50-8.68). For those with data on type of BCPR, 697 of 1411 (49.4%) received conventional CPR and 714 of 1411 (50.6%) received compression-only CPR. On multivariable analysis, only conventional CPR (adjusted proportion, 12.89%; 95% CI, 10.69-15.09; adjusted odds ratio, 2.06; 95% CI, 1.51-2.79) was associated with improved neurologically favorable survival compared with no BCPR (adjusted proportion, 9.59%; 95% CI, 6.45-8.61). There was a significant interaction of BCPR with age. Among infants, conventional BCPR was associated with improved overall survival and neurologically favorable survival while compression-only CPR had similar outcomes to no BCPR.
  
  
  
  Bystander CPR is associated with improved outcomes in pediatric OHCAs. Improving the provision of BCPR in minority communities and increasing the use of conventional BCPR may improve outcomes for children with OHCA.
authors.affiliation: The Cardiac Center, The Children's Hospital of Philadelphia, Perelman School of Medicine, The University of Pennsylvania, Philadelphia.
authors.forename: Maryam Y
authors.initials: MY
authors.lastname: Naim
authors.affiliation: Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles.
authors.forename: Rita V
authors.initials: RV
authors.lastname: Burke
authors.affiliation: Department of Emergency Medicine, Emory University, Atlanta, Georgia.
authors.forename: Bryan F
authors.initials: BF
authors.lastname: McNally
authors.affiliation: Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness and PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Lihai
authors.initials: L
authors.lastname: Song
authors.affiliation: Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness and PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Heather M
authors.initials: HM
authors.lastname: Griffis
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Berg
authors.affiliation: Department of Emergency Medicine, Emory University, Atlanta, Georgia.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Vellano
authors.affiliation: Sky Ridge Medical Center, Lone Tree, Colorado.
authors.forename: David
authors.initials: D
authors.lastname: Markenson
authors.affiliation: Division of Emergency Medicine, University of Texas Health Science Center, Houston.
authors.forename: Richard N
authors.initials: RN
authors.lastname: Bradley
authors.affiliation: The Cardiac Center, The Children's Hospital of Philadelphia, Perelman School of Medicine, The University of Pennsylvania, Philadelphia8Leonard Davis Institute, University of Pennsylvania, Philadelphia.
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Rossano
mesh_terms: D000293:Adolescent; D024201:Bystander Effect; D016887:Cardiopulmonary Resuscitation; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D058687:Out-of-Hospital Cardiac Arrest / Q000453:epidemiology / Q000628:therapy*; D012042:Registries; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology