Conventional versus hands-only cardiopulmonary resuscitation by bystanders for pediatrics with out-of-hospital cardiac arrest: A systematic review and meta-analysis.

Abstract

Background: Sudden cardiac arrest (SCA) in pediatric populations is a rare yet critical medical emergency characterized by high mortality and significant neurological impairment among survivors. This systematic review and meta-analysis aim to synthesize existing evidence on pediatric resuscitation techniques, focusing on survival rates, neurological outcomes, and the effectiveness of chest compression-only resuscitation (HCPR) versus standard resuscitation (CCPR), thereby addressing current gaps in clinical understanding and informing future guidelines.

Methods: Following PRISMA guidelines, we systematically searched the PubMed, Cochrane Library, and Embase databases for trials comparing HCPR versus CCPR during pediatric resuscitation. We used a comparative meta-analysis to estimate the odds ratio of prehospital return of spontaneous circulation (ROSC), 1-month survival rate, and survival with favorable neurological outcome. Study level odds ratios (ORs) and their 95% confidence intervals (CI) were pooled using random effects.

Results: Prehospital ROSC incidence did not significantly differ between HCPR and CCPR, including subgroup analysis based on cause of cardiac arrest. One-month survival rate was 12.3% in HCPR and 18.0% in CCPR (p = 0.04). Additionally, HCPR was less effective in non-cardiac arrest cases and in children over one year of age. Favorable neurological outcomes at one month were also lower for HCPR (6.3%) compared to CCPR (9.0%; p < 0.001), with similar trends observed across subgroups of non-cardiac arrest origin and varying age groups.

Conclusions: A pediatric resuscitation technique based solely on chest compressions shows lower efficacy in terms of survival at one month and quality of return of neurological function compared to standard resuscitation.