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Chest Compression–Only CPR Versus Conventional

Question Type:
Full Question:
Among infants and children who are in cardiac arrest in any setting (P), does does compression-only CPR (I), compared with compared with the use of conventional CPR (C), change neurologically intact survival at one year , neurologically intact survival at 30 days, survival to hospital discharge, improved ICU length of stay (O)?
Consensus on Science:
For the critical outcome of 1-year neurologically intact survival and the important outcome of improved ICU LOS, we identified no data.For the critical outcome of 30-day neurologically intact survival, we identified low-quality evidence from 2 pediatric observational studies of OHCA (n=5170 patients(Kitamura 2010, 1347-1354); n=5056 patients(Goto 2014, e000499)), downgraded for indirectness (dispatcher-assisted CPR), upgraded for effect size, showing that the use of compression-only CPR when compared with conventional CPR is associated with worse 30-day intact neurologic survival (RR, 0.46; 95% CI, 0.34–0.62). Further analysis of these 2 studies (pooled data) demonstrated no benefit on 30-day neurologically intact survival when comparing the use of bystander compression-only CPR with no bystander CPR being provided (RR, 1.21; 95% CI, 0.89–1.65).For the important outcome of survival to hospital discharge, no pediatric evidence was identified.
Treatment Recommendation:
We recommend that rescuers provide rescue breathing and chest compressions for pediatric IHCA and OHCA. If rescuers cannot provide rescue breaths, they should at least perform chest compressions (strong recommendation, low-quality evidence).Values, Preferences, and Task Force InsightsIn making these recommendations, we place a higher value on the importance of rescue breathing as part of CPR over a strategy that deemphasizes ventilation. The asphyxial nature of most pediatric cardiac arrests necessitates ventilation as part of effective CPR. Despite the low-quality evidence, the task force advocated for a strong recommendation to provide any CPR (including compression-only) in both in- and out-of-hospital settings; this is preferable to providing no intervention for a child in cardiac arrest. Registry data(Kitamura 2010, 1347-1354) do show that while infant outcomes are no different whether no CPR or compression-only CPR is attempted, children (older than infants) provided with at least compression-only CPR have better survival and neurologic outcomes compared with those subjects who have no CPR attempted.
CoSTR Attachments:
Peds 414 Compression only CPR vs Conventional CPR _papers_n.docx    
Should Compression-only CPR vs. Conventional CPR be used in Infants and children who are in cardiac .pdf    

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