Likelihood of Bystander CPR in Pediatric Cardiac Arrest

Introduction: From 2014 to 2015, over 7,000 pediatric patients experienced out-of-hospital cardiac arrest (OHCA). However, only 10.7% of these children survived to hospital discharge. Layperson cardiopulmonary resuscitation (CPR) has been shown to markedly improve out-of-hospital cardiac arrest outcomes in the adult population. Bystanders are not, however, always willing to perform CPR on adults before trained responders arrive, especially in impoverished areas and among minority populations. There is a lack of such data regarding the likelihood of bystanders to perform CPR on pediatric patients. 

Objective: To determine the incidence of layperson CPR in witnessed pediatric cardiac arrest and demographic factors that may impact the likelihood of layperson efforts.

Method: We conducted a retrospective observational study of pediatric patients less than 18 years of age who experienced witnessed OHCA from January 1, 2017–December 31, 2017. Inclusionary criteria consisted of patients identified as experiencing witnessed cardiac arrest prior to the arrival of emergency medical services personnel. Descriptive statistics and multivariate logistic regression were used to analyze the incidence of and influence upon performance of layperson CPR. 

Results: A total of 269 patients met inclusionary criteria, of whom 69.5% (160) were Caucasian, 39.4% (163) were male, and 42.8% (115) received layperson CPR. Of the patients receiving layperson CPR, 54.8% (63) were male and 45.2% (52) were female. Compared to males, female OHCA victims were more likely to receive layperson CPR (OR 2.05, p=0.04). Gender was the only factor that showed a statistically significant (p=0.048) difference in the likelihood of bystanders to perform CPR, with females 2.05 times more likely than males to receive layperson CPR. There was no difference in age, weight, race, and cardiac arrest etiology regarding performance of layperson CPR.

Conclusion: The percentage of pediatric OHCA patients receiving bystander CPR is unacceptably low, and bystanders appear to exhibit a bias toward providing CPR to pediatric females. Further public initiatives are needed to increase bystander CPR and to decrease bystander bias.