Association between bystander-initiated cardio-pulmonary resuscitation in pediatric out-of-hospital cardiac arrest and patient outcomes: Results from the French National Registry

Purpose

Effects of bystander cardiopulmonary resuscitation (CPR) on patient outcomes during pediatric out-of-hospital cardiac arrest (OHCA) remain to be fully elucidated. This study investigated bystander-initiated CPR effects on return of spontaneous circulation (ROSC) and survival at hospital admission in comparative pediatric population experiencing OHCA.

Methods

Multicenter retrospective observational study conducted between January 2015 and December 2023 using the French National Cardiac Arrest Registry (RéAC) data. Pediatric patients (0–17 years) with OHCA were included. Patients who received bystander-initiated CPR were matched with those who did not using propensity score. Primary endpoints were ROSC and survival at hospital admission. Secondary endpoints were survival at D30 and favorable neurological outcomes (Cerebral Performance Category (CPC score of 1 or 2).

Results

Of 2162 eligible pediatric patients, 1289 (59.6 %) received bystander-initiated CPR. After propensity score matching (n = 645 pairs), bystander-initiated CPR (vs without CPR by a bystander) was associated with improved ROSC (31.2 % vs 23.7 %; adjusted OR [AOR] 1.7, 95 % CI 1.1–1.9) and survival at hospital admission (28.7 % vs 19.8 %; AOR 1.7, 95 % CI 1.3–2.2). No significant difference was observed for survival at D30 (3.7 % vs 3.9 %; AOR 0.9, 95 % CI 0.5–1.7) or favorable neurological outcomes.

Conclusions

In this nationwide French cohort, bystander-initiated CPR in pediatric OHCA was associated with improved ROSC and survival at hospital admission, but not with D30 survival or favorable neurological outcomes. These findings reinforce the importance of promoting bystander CPR, while highlighting the need for additional strategies to improve long-term outcomes in pediatric OHCA.