Compression-Only Versus Rescue-Breathing Cardiopulmonary Resuscitation After Pediatric Out-of-Hospital Cardiac Arrest,Journal of the American College of Cardiology

当前位置： X-MOL 学术 › J. Am. Coll. Cardiol. › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

Compression-Only Versus Rescue-Breathing Cardiopulmonary Resuscitation After Pediatric Out-of-Hospital Cardiac Arrest
Journal of the American College of Cardiology ( IF 24.0 ) Pub Date : 2021-08-30 , DOI: 10.1016/j.jacc.2021.06.042
Maryam Y Naim ₁ , Heather M Griffis ₂ , Robert A Berg ₃ , Richard N Bradley ₄ , Rita V Burke ₅ , David Markenson ₆ , Bryan F McNally ₇ , Vinay M Nadkarni ₃ , Lihai Song ₂ , Kimberly Vellano ₇ , Victoria Vetter ₈ , Joseph W Rossano ₉

Affiliation

The Cardiac Center, Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Division of Emergency Medicine, University of Texas Health Science Center, Houston, Texas, USA.
Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Sky Ridge Medical Center, Lone Tree, Colorado, USA.
Department of Emergency Medicine, Emory University, Atlanta, Georgia, USA.
The Cardiac Center, Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
The Cardiac Center, Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA; Leonard Davis Institute, The University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Background

There are conflicting data regarding the benefit of compression-only bystander cardiopulmonary resuscitation (CO-CPR) compared with CPR with rescue breathing (RB-CPR) after pediatric out-of-hospital cardiac arrest (OHCA).

Objectives

This study sought to test the hypothesis that RB-CPR is associated with improved neurologically favorable survival compared with CO-CPR following pediatric OHCA, and to characterize age-stratified outcomes with CPR type compared with no bystander CPR (NO-CPR).

Methods

Analysis of the CARES registry (Cardiac Arrest Registry to Enhance Survival) for nontraumatic pediatric OHCAs (patients aged ≤18 years) from 2013-2019 was performed. Age groups included infants (<1 year), children (1 to 11 years), and adolescents (≥12 years). The primary outcome was neurologically favorable survival at hospital discharge.

Results

Of 13,060 pediatric OHCAs, 46.5% received bystander CPR. CO-CPR was the most common bystander CPR type. In the overall cohort, neurologically favorable survival was associated with RB-CPR (adjusted OR: 2.16; 95% CI: 1.78-2.62) and CO-CPR (adjusted OR: 1.61; 95% CI: 1.34-1.94) compared with NO-CPR. RB-CPR was associated with a higher odds of neurologically favorable survival compared with CO-CPR (adjusted OR: 1.36; 95% CI: 1.10-1.68). In age-stratified analysis, RB-CPR was associated with better neurologically favorable survival versus NO-CPR in all age groups. CO-CPR was associated with better neurologically favorable survival compared with NO-CPR in children and adolescents, but not in infants.

Conclusions

CO-CPR was the most common type of bystander CPR in pediatric OHCA. RB-CPR was associated with better outcomes compared with CO-CPR. These results support present guidelines for RB-CPR as the preferred CPR modality for pediatric OHCA.

中文翻译：

小儿院外心脏骤停后仅加压与人工呼吸心肺复苏

背景

在儿科院外心脏骤停 (OHCA) 后，仅按压旁观者心肺复苏 (CO-CPR) 与人工呼吸心肺复苏 (RB-CPR) 相比，其益处存在相互矛盾的数据。

目标

本研究试图检验与儿科 OHCA 后的 CO-CPR 相比，RB-CPR 与改善的神经系统有利生存率相关的假设，并表征 CPR 类型与无旁观者 CPR (NO-CPR) 相比的年龄分层结果。

方法

对 2013-2019 年非创伤性儿科 OHCA（≤18 岁患者）的 CARES 登记（心脏骤停登记以提高生存率）进行了分析。年龄组包括婴儿（<1 岁）、儿童（1 至 11 岁）和青少年（≥12 岁）。主要结果是出院时神经系统良好的存活率。

结果

在 13,060 名儿科 OHCA 中，46.5% 接受了旁观者 CPR。CO-CPR 是最常见的旁观者 CPR 类型。在整个队列中，与 NO-相比，神经功能良好的生存率与 RB-CPR（调整后的 OR：2.16；95% CI：1.78-2.62）和 CO-CPR（调整后的 OR：1.61；95% CI：1.34-1.94）相关心肺复苏术。与 CO-CPR 相比，RB-CPR 与更高的神经系统良好存活率相关（调整后的 OR：1.36；95% CI：1.10-1.68）。在年龄分层分析中，在所有年龄组中，RB-CPR 与 NO-CPR 相比，与更好的神经学有利生存率相关。在儿童和青少年中，与 NO-CPR 相比，CO-CPR 与更好的神经系统有利生存率相关，但在婴儿中则不然。