b'202021 CARES Annual Report Research HighlightsCompression-only CPR vs. CPR with Rescue Breathing for Pediatric Out-of-Hospital Cardiac Arrest By Maryam Naim, MD, MSCE, Childrens Hospital of PhiladelphiaSince 2010 the American Heart Association has been recommending compression only CPR (CO-CPR) for lay rescuers of adult out-of-hospital cardiac arrest (OHCA). The impact of this effort on pediatric OHCA was unknown. Children experience more asphyxial arrests and therefore CPR with rescue breathing (RB-CPR) is the preferred modality for bystander CPR.Increasingly I was observing that children who had an OHCA were receiving CO-CPR and I wanted to know whether their outcomes were being impacted, explained Maryam Naim, lead author7 It was also possible that some age groups, like adolescents who have more shockable and primary cardiac events, would benefit from CO-CPR; however, age stratified analyses had not been previously performed.The investigators had previous experience using the CARES registry and were confident that these questions could be answered using CARES data. An analysis of the Cardiac Arrest Registry to Enhance Survival for non-traumatic pediatric OHCAs (18 years) from January 2013 through December 2018 was conducted. Age groups included infants (1 year), children (1 to 11 years), and adolescents (12 years). The primary outcome was neurologically favorable survival at the time of hospital discharge, defined as a cerebral performance category (CPC) score of 1 or 2.Of the 13,060 pediatric cardiac arrests captured in the CARES database, 46.5% received bystander CPR. In arrests where the type of bystander CPR was known, 45.3% received RB-CPR whereas 55.6% received CO-CPR (1% received CPR with ventilations only). Arrests were more common in infants, males, and White and Black children. The majority of arrests were unwitnessed, occurred in a home/residence, presented with a non-shockable rhythm, and had no AED use prior to EMS arrival. Over the 6-year period of the study, the rates of bystander CPR did not change, but there was a significant increase in the proportion of pediatric OHCA receiving CO-CPR. Bystander CPR was most commonly provided by a family member (71.7%), followed by lay person (21.9%), and lay person with medical training (6.4%). Lay person family members (CO-CPR: 54.8%) and lay persons (CO-CPR: 58.9%) were more likely to perform CO-CPR, whereas lay persons with medical training were more likely to perform RB-CPR (61.5%).Neurologically favorable survival was observed in 8.6% of cardiac arrests. Over the 6-year study period, there was no change in neurologically favorable survival. OHCAs with RB-CPR and CO-CPR had better outcomes compared with NO-CPR (RB-CPR 13.4%, CO-CPR 12.2%, NO-CPR 5.8%, p0.001). In multivariable analysis, RB-CPR (adjusted proportion: 12.0%, 95% CI: 10.7-13.2; adjusted OR: 2.16, 95% CI: 1.78-2.62) and CO-CPR (adjusted proportion: 9.7%, 95% CI: 8.7-10.7; adjusted OR: 1.61, 95% CI: 1.34-1.94) were both independently associated with neurologically favorable survival compared with NO-CPR (adjusted proportion: 6.8%, 95% CI: 6.2-7.4). Neurologically favorable survival was observed in 4.6% of infants, 10.6% of children, and 16.5% adolescents. In infants, neurologically favorable survival was observed in 5.2% arrests with CO-CPR, 6.9% with RB-CPR, and 3.7% with NO-CPR; p 0.001. In multivariable analysis, RB-CPR was associated with neurologically favorable survival compared with NO-CPR (adjusted OR: 1.65, 95% CI: 1.19-2.30); however, CO-CPR was not associated with outcome. In children, neurologically7Naim MY, Griffis HM, Berg RA, Bradley RN, Burke RV, Markenson D, McNally BF, Nadkarni VM, Song L, Vellano K, Vetter V, Rossano JW. Compression-Only Versus Rescue-Breathing Cardiopulmonary Resuscitation After Pediatric Out-of-Hospital Cardiac Arrest. J Am Coll Cardiol. 78(10):1042-1052.'