Bystander cardiopulmonary resuscitation: a chance to save a life.

www.pccmjournal. org 223 In October 2010, the most recent iteration of the Consensus on Science and Treatment Recommendations for Pediatric Advanced Life Support presented trends in survival statistics from 25 yrs of published studies in pediatric cardiac arrest (1). Over that time period, survival from in-hospital cardiac arrest appeared to improve from 10% to 15% in the 1980s to approximately 25% in 2006 (1–4). In contrast, survival from out-of-hospital pediatric cardiac arrest has remained 6%–9% for many years in North America and Europe (1, 5–7). Clearly, much work needs to be done to better understand and treat out-of-hospital cardiac arrests in children.In this issue of Pediatric Critical Care Medicine, Akahane et al (8) provide important new information from their population-based study of 7,624 pediatric out-of-hospital cardiac arrests in Japan from 2005 to 2008. Among the important findings are 1) the significant association between bystander cardiopulmonary resuscitation (CPR) and 1-month neurologically favorable survival, 2) lower survival rates and lower rates of neurologically favorable survival for high-school-aged patients compared with younger children, and 3) higher survival rates with use of either public access defibrillation or defibrillation by emergency medical service providers. Overall survival from pediatric out-of-hospital cardiac arrest in Japan from 2005 to 2008 was 11%, higher than most other published studies (1, 6, 8). Although many factors may explain the higher survival rate, the high rate of bystander CPR, 48%, is especially impressive. In contrast, the recent 11-site multicenter National Heart, Lung and Blood Institute Resuscitation Outcomes Consortium study of pediatric out-of-hospital cardiac arrest from 2005 to 2007 in the United States and Canada showed a bystander CPR rate of 35% and survival rate of 6.4% (5, 7). Furthermore, bystander CPR rates for pediatric out-of-hospital cardiac arrests in North America and Europe have hovered around 33% for many years (1, 6). Interestingly, studies in Japan over several years have consistently documented bystander CPR rates from 41% to 48%(8–10). Of course, it is well known that bystander CPR improves outcomes of adults with out-of-hospital cardiac arrests (1, 10). Nevertheless, multiple studies of pediatric out-ofhospital cardiac arrest have not been able to demonstrate the association between bystander CPR and survival, presumably because of inadequate power (5, 6). Importantly, the Japanese data establish that bystander CPR for pediatric out-of-hospital cardiac arrests is associated with higher survival rates (8, 9). Interestingly, Akahane et al also showed that bystander CPR was performed less often in highschool-aged patients and suggested that this factor may have contributed to the lower survival rate in these older children. In addition, the authors documented that public access defibrillation and EMS-provided defibrillation was life saving for these children with out-of-hospital cardiac arrests (8). These findings are another sober reminder that cardiac arrests due to ventricular fibrillation and pulseless ventricular tachycardia (VF/pVT) are not just an adult problem. Children suffer from VF/pVT, and providers must first consider that possibility, and then identify a shockable rhythm, before they can save a life with a successful defibrillation (1, 4, 5, 7, 8). A science advisory statement published by the American Heart Association in 2011 reviewed data on sudden cardiac arrest in adolescents, including attitudes and barriers to CPR provision among young people (11). The summary statement recommended that “training in CPR be a requirement for graduation from secondary schools. ” These data from Kahane et al highlight the deficiency in bystander CPR provision for adolescents and provide further support for the concept of CPR training in schools. We congratulate Akahane et al for another outstanding contribution to the pediatric cardiac arrest and resuscitation literature from their national out-of-hospital CPR registry. Their data demonstrate once again that bystander CPR is “A Chance To Save A Life. ”