Clinical paper| Volume 170, P17-25, January 2022

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Bystander cardiopulmonary resuscitation for paediatric out-of-hospital cardiac arrest in England: An observational registry cohort study



      Bystander cardiopulmonary resuscitation (BCPR) is strongly advocated by resuscitation councils for paediatric out-of-hospital cardiac arrests (OHCAs). However, there are limited reports on rates of BCPR in children and its relationship with return of spontaneous circulation (ROSC) or survival outcomes.


      We describe the rate of BCPR and its association with any ROSC and survival- to- hospital-discharge.


      We conducted retrospective analysis of prospectively collected paediatric (<18 years of age) OHCA cases in England; we included specialist registry patients treated by emergency medical services (EMS) with known BCPR status and outcome between January 2014 and November 2018. Data included patient demographics, aetiology, witness status, initial rhythm, EMS, season, time of day and bystander status. Associations between BCPR, and any ROSC and survival-to-hospital-discharge outcomes were explored using multivariable logistic regression.


      There were 2363 paediatric OHCAs treated across 11 EMS regions. BCPR was performed in 69.6% (1646/2363) of the cases overall (range 57.7% (206/367) to 83.7% (139/166) across EMS regions). Only 34.9% (550/1572) of BCPR cases were witnessed. Overall, any ROSC was achieved in 22.8% (523/2289) and survival to hospital discharge in 10.8% (225/2066). Adjusted odds ratio (aOR) for any ROSC was significantly improved following BCPR compared to no BCPR (aOR 1.37, 95% CI 1.03–1.81), but adjusted odds ratio for survival-to-hospital-discharge were similar (aOR 1.01, 95% CI 0.66–1.55).


      BCPR was associated with improved rates of any ROSC but not survival-to-hospital-discharge. Variations in EMS BCPR rates may indicate opportunities for regional targeted increase in public BCPR education.


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        • Perkins G.D.
        • Handley A.J.
        • Koster R.W.
        • et al.
        European Resuscitation Council Guidelines for Resuscitation 2015: Section 2. Adult basic life support and automated external defibrillation.
        Resuscitation. 2015; 95: 81-99
        • Olasveengen T.M.
        • de Caen A.R.
        • Mancini M.E.
        • et al.
        2017 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations Summary.
        Resuscitation. 2017; 121: 201-214
        • Maconochie I.K.
        • Aickin R.
        • Hazinski M.F.
        • et al.
        Pediatric Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.
        Resuscitation. 2020; 156: A120-A155
        • Naim M.Y.
        • Burke R.V.
        • McNally B.F.
        • et al.
        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.
        JAMA Pediatr. 2017; 171: 133-141
        • Deasy C.
        • Bray J.
        • Smith K.
        • et al.
        Paediatric hanging associated out of hospital cardiac arrest in Melbourne, Australia: characteristics and outcomes.
        Emerg Med J. 2011; 28: 411-415
        • Topjian A.A.
        • Telford R.
        • Holubkov R.
        • et al.
        Association of Early Postresuscitation Hypotension With Survival to Discharge After Targeted Temperature Management for Pediatric Out-of-Hospital Cardiac Arrest: Secondary Analysis of a Randomized Clinical Trial.
        JAMA Pediatr. 2018; 172: 143-153
      1. Ho Y, Mok Y. Epidemiology of paediatric out-of-hospital cardiac arrest presented to a local emergency departmentA retrospective case series; 2016.

        • Kuisma M.
        • Suominen P.
        • Korpela R.
        Paediatric out-of-hospital cardiac arrests–epidemiology and outcome.
        Resuscitation. 1995; 30: 141-150
        • Chang I.
        • Lee S.C.
        • Shin S.D.
        • et al.
        Effects of dispatcher-assisted bystander cardiopulmonary resuscitation on neurological recovery in paediatric patients with out-of-hospital cardiac arrest based on the pre-hospital emergency medical service response time interval.
        Resuscitation. 2018; 130: 49-56
        • Donoghue A.J.
        • Nadkarni V.
        • Berg R.A.
        • et al.
        Out-of-hospital pediatric cardiac arrest: an epidemiologic review and assessment of current knowledge.
        Ann Emerg Med. 2005; 46: 512-522
        • Gelberg J.
        • Strömsöe A.
        • Hollenberg J.
        • et al.
        Improving Survival and Neurologic Function for Younger Age Groups After Out-of-Hospital Cardiac Arrest in Sweden.
        Pediatric Crit Care Med. 2015; 16: 750-757
        • Kitamura T.
        • Kiyohara K.
        • Nitta M.
        • Nadkarni V.M.
        • Berg R.A.
        • Iwami T.
        Survival following witnessed pediatric out-of-hospital cardiac arrests during nights and weekends.
        Resuscitation. 2014; 85: 1692-1698
        • Kiyohara K.
        • Sado J.
        • Kitamura T.
        • et al.
        Public-access automated external defibrillation and bystander-initiated cardiopulmonary resuscitation in schools: a nationwide investigation in Japan.
        Europace. 2019; 21: 451-458
        • Hawkes C.
        • Booth S.
        • Ji C.
        • et al.
        Epidemiology and outcomes from out-of-hospital cardiac arrests in England.
        Resuscitation. 2017; 110: 133-140
        • Perkins G.D.
        • Brace-McDonnell S.J.
        The UK Out of Hospital Cardiac Arrest Outcome (OHCAO) project.
        BMJ Open. 2015; 5e008736
      2. England N. New ambulance service standards announced.

      3. (JRALC). AoACEaJRCALC. UK Ambulance Services Clinical Practice Guidelines. London; 2013.

        • Zaritsky A.
        • Nadkarni V.
        • Hazinski M.F.
        • et al.
        Recommended guidelines for uniform reporting of pediatric advanced life support: the pediatric Utstein style.
        Ann Emerg Med. 1995; 26: 487-503
        • Ro Y.S.
        • Shin S.D.
        • Song K.J.
        • et al.
        Effects of Dispatcher-assisted Cardiopulmonary Resuscitation on Survival Outcomes in Infants, Children, and Adolescents with Out-of-hospital Cardiac Arrests.
        Resuscitation. 2016; 108: 20-26
        • Goto Y.
        • Maeda T.
        • Goto Y.
        Impact of dispatcher-assisted bystander cardiopulmonary resuscitation on neurological outcomes in children with out-of-hospital cardiac arrests: a prospective, nationwide, population-based cohort study.
        J Am Heart Assoc. 2014; 3e000499
        • Herlitz J.
        • Engdahl J.
        • Svensson L.
        • Young M.
        • Angquist K.A.
        • Holmberg S.
        Characteristics and outcome among children suffering from out of hospital cardiac arrest in Sweden.
        Resuscitation. 2005; 64: 37-40
        • Perkins G.D.
        • Lockey A.S.
        • de Belder M.A.
        • Moore F.
        • Weissberg P.
        • Gray H.
        National initiatives to improve outcomes from out-of-hospital cardiac arrest in England.
        Emerg Med J. 2016; 33: 448-451
        • Hawkes C.A.
        • Brown T.P.
        • Booth S.
        • et al.
        Attitudes to Cardiopulmonary Resuscitation and Defibrillator Use: A Survey of UK Adults in 2017.
        J Am Heart Assoc. 2019; 8e008267
        • Hasselqvist-Ax I.
        • Riva G.
        • Herlitz J.
        • et al.
        Early cardiopulmonary resuscitation in out-of-hospital cardiac arrest.
        N Engl J Med. 2015; 372: 2307-2315
        • Brown T.P.
        • Booth S.
        • Hawkes C.A.
        • et al.
        Characteristics of neighbourhoods with high incidence of out-of-hospital cardiac arrest and low bystander cardiopulmonary resuscitation rates in England.
        Eur Heart J Qual Care Clin Outcomes. 2019; 5: 51-62
        • Fosbol E.L.
        • Dupre M.E.
        • Strauss B.
        • et al.
        Association of neighborhood characteristics with incidence of out-of-hospital cardiac arrest and rates of bystander-initiated CPR: implications for community-based education intervention.
        Resuscitation. 2014; 85: 1512-1517
        • Fink E.L.
        • Prince D.K.
        • Kaltman J.R.
        • et al.
        Unchanged pediatric out-of-hospital cardiac arrest incidence and survival rates with regional variation in North America.
        Resuscitation. 2016; 107: 121-128
        • Rajan S.
        • Wissenberg M.
        • Folke F.
        • et al.
        Out-of-hospital cardiac arrests in children and adolescents: incidences, outcomes, and household socioeconomic status.
        Resuscitation. 2015; 88: 12-19
        • Marenco J.P.
        • Wang P.J.
        • Link M.S.
        • Homoud M.K.
        • Estes 3rd., N.A.
        Improving survival from sudden cardiac arrest: the role of the automated external defibrillator.
        JAMA. 2001; 285: 1193-1200
        • Chang I.
        • Ro Y.S.
        • Shin S.D.
        • Song K.J.
        • Park J.H.
        • Kong S.Y.
        Association of dispatcher-assisted bystander cardiopulmonary resuscitation with survival outcomes after pediatric out-of-hospital cardiac arrest by community property value.
        Resuscitation. 2018; 132: 120-126
        • Girotra S.
        • Spertus J.A.
        • Li Y.
        • et al.
        Survival trends in pediatric in-hospital cardiac arrests: an analysis from Get With the Guidelines-Resuscitation.
        Circ Cardiovasc Qual Outcomes. 2013; 6: 42-49
        • Atkins D.L.
        • Everson-Stewart S.
        • Sears G.K.
        • et al.
        Epidemiology and outcomes from out-of-hospital cardiac arrest in children: the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest.
        Circulation. 2009; 119: 1484-1491
        • Dowie R.
        • Campbell H.
        • Donohoe R.
        • Clarke P.
        'Event tree' analysis of out-of-hospital cardiac arrest data: confirming the importance of bystander CPR.
        Resuscitation. 2003; 56: 173-181
        • Kitamura T.
        • Iwami T.
        • Kawamura T.
        • et al.
        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.
        The Lancet. 2010; 375: 1347-1354
        • Herlitz J.
        • Ekström L.
        • Wennerblom B.
        • Axelsson A.
        • Bång A.
        • Holmberg S.
        Type of arrhythmia at EMS arrival on scene in out-of-hospital cardiac arrest in relation to interval from collapse and whether a bystander initiated CPR.
        Am J Emerg Med. 1996; 14: 119-123