Rescue Breathing Improves CPR Outcomes in Kids

Reed Miller

March 10, 2010

March 10, 2010 (Kyoto, Japan) — A large population-based study of pediatric cardiac-arrest patients shows that conventional cardiopulmonary resuscitation (CPR)--with rescue breathing ventilations--is the best approach to resuscitating children outside the hospital [1].

In a study supported by the All-Japan Utstein Registry of the Fire and Disaster Management Agency, Dr Tetsuhisa Kitamura (Kyoto University Health Service, Japan) and colleagues collected data from 5170 children 17 and under with an out-of-hospital cardiac arrest. According to the authors, it is the first study powered to measure the benefits of CPR in pediatric patients.

The results, published online March 3, 2010 in the Lancet, show that bystander CPR without rescue breathing had a much higher rate of favorable neurological outcomes than children who received no CPR. Favorable neurological outcome was defined as a Glasgow-Pittsburgh cerebral performance category of 1 or 2 one month after the arrest.

The study also found that, in children older than one year suffering cardiac arrest from a noncardiac cause such as drug overdose, hanging, drowning, or trauma (71% of the children in the study), CPR with rescue-breathing yielded better results than compression-only CPR. In children in cardiac arrest due to cardiac causes, both types of CPR yielded similar success rates.

Outcomes were uniformly poor in infants younger than one year regardless of resuscitation. Neurologically intact survival rates were around 2% with cardiac arrest of noncardiac origin and about 1% for cardiac arrest of cardiac origins in this population.

Percentage of Patients Aged 1 to 17 Surviving Neurologically Intact for 1 Month Postarrest

Origin No CPR (n=2719) Bystander CPR (n=2439) CPR vs no CPR, odds ratio (95% CI) Compression-only CPR (n=888)


Conventional CPR (n=1551)


Conventional CPR vs compression-only, odds ratio (95% CI)


Noncardiac (n=3675)






4.17 (2.37–7.32)






5.54 (2.52–16.99)


Cardiac (n=1495)






2.21 (1.08–4.54)






1.2 (0.55–2.66)


Based on the results, Kitamura et al "strongly recommend that conventional CPR, including rescue breathing, continue to be the standard treatment for children who have out-of-hospital cardiac arrests with presumed noncardiac causes."

However, previous research shows that bystanders are more willing to do CPR with chest compressions only, without the ventilations, and the American Heart Association's Hands-Only CPR public-education program tells people to just call 911 and begin chest compressions on a person who has collapsed.

Therefore, since the study showed that compression-only CPR was better than no CPR at all, Kitamura et al recommend that the hands-only approach be taught to the general public to increase the overall rate of bystander CPR. People who are likely to witness children in cardiac arrest--teachers, parents, lifeguards--should receive additional training to perform conventional CPR with rescue breathing, they recommend.

"Citizens would be increasingly taught compression-only CPR--a simpler technique that is easier to learn, remember, and undertake than is conventional CPR. If a bystander has learned chest-compression–only CPR, or if a member of the emergency-telephone dispatcher system prefers to teach chest-compression-only CPR rather than conventional CPR because conventional CPR is difficult, the bystander should be encouraged to provide compression-only CPR rather than no bystander CPR."

But Dr Jesus López-Herce and Dr Angel Carrillo Alvarez (Hospital General Universitario Gregorio Marañón, Madrid, Spain) argue, in an accompanying editorial, that the "double-training" strategy advocated by Kitamura and colleagues "could mean that most children would be resuscitated with compression-only CPR, reducing their possibility of survival" [2].

They suggest teaching everyone conventional CPR with ventilations, with the caveat that compression-only CPR is the best approach in adults suspected of cardiac arrest of cardiac origin, but concede that further research is needed to assess the merits of that approach. And, until further research on the best approach to teaching CPR to the whole population can be completed, chest compression plus ventilation should continue to be taught to the whole population, and no changes should be made to the recommendations for pediatric bystander-initiated CPR, López-Herce and Alvarez maintain.


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