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Cardiopulmonary Resuscitation
with Rescue Breathing Is Superior
to Hands-Only Cardiopulmonary
Resuscitation for Children and
Infants: Results of a Systematic
Review
Joseph W. Rossano
Richard N. Bradley
Children’s Hospital of Philadelphia / University of Pennsylvania
The University of Texas Health Science Center at Houston
For the American Red Cross Scientific Advisory Council
Abstract 190
Financial Disclosures
The authors have no relevant financial conflicts
to disclose.
Introduction
• Evidence supports teaching hands-only CPR for
the initial treatment of cardiac arrest in adults.
Unlike adults, however, children and infants with
cardiac arrest are more likely to have noncardiac causes.
• Hypothesis: The objective of this project was to
conduct a structured literature review to answer
the question, “In children and infants with
cardiac arrest treated in an out-of-hospital
setting, does compression-only CPR, alone or
with supplemental oxygen, compared to CPR
with rescue breathing lead to improved
outcomes?”
Methods
We performed a MEDLINE search ("compression
only"[Title/Abstract]) AND cardiopulmonary
resuscitation[MeSH Terms] with limits children (ages 0 -18).
We also performed a search in the Cochrane database for
systematic reviews, the Central Register of Controlled
Trials, and EMBASE using similar search terms. We also
searched applicable bibliographies and used the ‘Cited By’
function in Google Scholar. The study included papers if
they evaluated the difference between compression only
CPR and CPR with rescue breathing in infants or children.
Papers that reported results from studies that used
procedures that were beyond the basic life support level
were excluded. Each paper was evaluated using specific
criteria to determine the level of evidence.
Results
Sixty-nine records were identified and screened.
Fifty-four of these did not meet inclusion/exclusion
criteria, leaving fifteen full-text articles that we
assessed for eligibility. Eleven of these did not
meet inclusion/exclusion criteria, leaving four that
we included in the qualitative synthesis. Of these,
one good quality study with level of evidence
(LOE) 2a and 3 other studies (LOE 4) all opposed
the hypothesis. There is a relative paucity of
published data on this subject. The majority of the
papers published describe evidence from animal
models.
Key Studies
• Berg, R. A., R. W. Hilwig, et al. (1999). "Simulated mouth-tomouth ventilation and chest compressions (bystander
cardiopulmonary resuscitation) improves outcome in a swine
model of prehospital pediatric asphyxial cardiac arrest." Crit
Care Med 27(9): 1893-1899.
• Berg, R. A., R. W. Hilwig, et al. (2000). ""Bystander" chest
compressions and assisted ventilation independently improve
outcome from piglet asphyxial pulseless "cardiac arrest"."
Circulation 101(14): 1743-1748.
Outcome
Odds Ratio
95% c.i.
24 hr survival
8
2.3 – 32
24 hr neurologically
intact
11.4
2.8 - 47
Key Studies
• Kitamura, T., T. Iwami, et al. (2010). “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.” Lancet
375(9723): 1347-1354.
Type
1 month outcome
Odds ratio
95% c.i.
Noncardiac
survival
1.89
1.21-3.82
Noncardiac
neurologically intact
5.54
2.52-16.99
Cardiac
survival
1.07
0.53-2.15
Cardiac
neurologically intact
0.96
0.52-1.75
Conclusions
In conclusion, rescuers
should provide chest
compressions with
rescue breathing to
children and infants in
cardiac arrest; rescuers
unwilling or unable to
provide compressions
with rescue breathing
may provide chest
compressions alone for
these patients.
Recommendation
• Standards: None
• Guidelines: Rescuers
should provide chest
compressions with
ventilations to children
and infants in cardiac
arrest.
• Options: Rescuers
unwilling or unable to
provide compressions
with ventilations may
provide chest
compressions only to
infants and children.