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Bystander CPR delivers benefits in children

ESC Press Statement

A Japanese study, published in The Lancet, has found that for children who have cardiac arrests outside of a hospital, cardiopulmonary resuscitation (CPR) delivered by bystanders increases their likelihood of survival. (1) 

The study, by Tetsuhisa Kitamura and colleagues from Kyoto University Health Service, involving 5,170 children aged 17 years and under, showed that at one month favourable neurological outcomes were around three times more likely for children given any form of CPR by a bystander than for those who had not. The study also demonstrated that in children whose cardiac arrests had a non-cardiac cause (such as drowning), conventional CPR (including rescue breathing), was more likely to improve survival than compression-only CPR. However, for children whose arrests were cardiac in origin, both CPR types delivered the same benefits in survival.

Ventricular Arrhythmias and Sudden Cardiac Death (SCD)

Commenting on the study, European Society of Cardiology (ESC) spokesperson, Professor Gerasimos Filippatos from Athens University Hospital Attikon (Greece) said: “This paper is important because it proves what we have suspected (and intuitively recommended) all along, that the management of cardiac arrest should be different in children.”

The majority of cardiac arrests in adults have a cardiac origin, he said, while in children non cardiac causes are far more common. “The study shows clearly that when children experience an out of hospital cardiac arrest, both their circulation and respiration need to be supported. Such 'rescue breaths' should remain a key feature of paediatric guidelines,” said Professor Filippatos, adding that the study also made the important point that the results of studies in adult populations cannot be extrapolated directly to children.

Last year the American Heart Association (AHA) said that if a bystander is not trained in cardiopulmonary resuscitation (CPR), they should provide only chest compressions in adults who experience out of hospital cardiac arrest, but acknowledged that pediatric victims benefit from conventional CPR including ‘rescue breaths'. Guidelines from the European Resuscitation Council (ERC), that state that bystanders should provide chest compressions and mouth-to-mouth ventilation for adults and children, are due to be updated in September 2010. 

The study, said Professor Filippatos, also demonstrated the importance of placing greater emphasis on training the public in bystander resuscitation. “While 1.4 million citizens are trained in CPR each year in Japan, such programmes are available to just a fraction of the European population. Special training programmes also need to be offered to professionals working with children to teach the best techniques for this group.”

While bystander CPR studies are difficult to undertake due to inherent problems of randomising members of the public, there is an urgent need for more randomised controlled studies in the field of advanced cardiac life support. “The focus needs to be increased in this area to save lives, since only a very small percentage of people suffering out of hospital cardiac arrest survive to out of hospital discharge,” said Professor Filippatos.


(1) Conventional and chest-compression-only cardiopulmonary resuscitation by bystanders for children who have out-of-hospital cardiac arrests: a prospective, nationwide, population-based cohort study. T Kitamura, T Iwami, T Kawamura, et al. The Lancet. Published on-line March 3, 2010. DOI: 10.1016/S)140-6736(10)60064-5.

Notes to editor

* More on the European Resuscitation Council (ERC):

The European Society of Cardiology (ESC) represents more than 62,000 cardiology professionals across Europe and the Mediterranean. Its mission is to reduce the burden of cardiovascular disease in Europe.