First Aid classes | Conventional CPR education efforts should intensify for children

Education efforts to teach bystander CPR should intensify in minority communities, according to the lead author of a recent study that showed Hispanic and African-American children were less likely to get CPR with breaths, which had improved survival compared to compression-only CPR or no CPR.

The data indicates that “while a lot of the public health efforts have focused on Hands-Only CPR, I think that we need to emphasize that children need conventional CPR—and that they have better [neurological] outcomes,” said lead author Maryam Y. Naim, M.D., an assistant professor of critical care medicine and pediatrics at the University of Pennsylvania Perelman School of Medicine.

During the –study, researchers looked at patient records from 3,900 children who had an out-of-the-hospital cardiac arrest at home or in a public place between 2013 and 2015. A little more than half of the children taken to the hospital with cardiac arrest don’t get CPR from parents or bystanders.

The data came from a registry that collects information on adults and children from more than two-dozen states. Nearly 60 percent of the study participants were infants, and about 31 percent were white. Almost 30 percent were African-American and nearly 12 percent were Hispanic.

The report showed that bystanders administered CPR about 56 percent of the time when white children had a cardiac arrest compared to about 40 percent of the time for children who were African-American, Hispanic, or another race or ethnicity. Children older than 1 year and African-American and Hispanic children were more likely to receive compression-only CPR than conventional CPR.

Naim, a cardiac intensivist at Children’s Hospital of Philadelphia, said the differences by race and ethnicity surprised her and makes it critical that health care professionals step up their CPR education efforts in Hispanic and African-American neighborhoods.

While residents of both Hispanic and African-American neighborhoods are more likely to have an out-of-hospital cardiac arrest than white communities, people in those areas are less likely to get CPR from persons around them.

According to a report from the American Heart Association, about 350,000 Americans have a cardiac arrest every year and about 7,000 of them are children. The AHA recommends doing compressions first and then the breathing techniques in pediatric CPR.

Only about a third of children who have had cardiac arrest receive CPR, according to previous studies.

The number of children getting CPR is increasing, but “still, again, this is a very low number,” Naim said.

She said she and her colleagues will dig deeper into the data to look at patterns by income, rural and urban areas and regions.

The Oklahoma City Fire Department offers free CPR education classes. Instructors review basic conventional CPR techniques. They also encourage people to give only chest compressions if they’re reluctant to give mouth-to-mouth breathing, said Maj. Derrick Kiel, a certified CPR instructor with the department.

Kiel said he and the other instructors reiterate to participants that conventional CPR is the preferred technique for children.

“If we correct the breathing problem, then we usually also correct the full arrest,” said the longtime firefighter, who is also a paramedic.

Joshua Koch, M.D. a longtime critical care physician and co-chair of the CPR committee of Children’s Health in Dallas, said more research is needed on CPR in children. Although the survival rates were known previously, they’re important because “surprisingly, that hasn’t been shown before in this patient population.”

His message to pediatricians: encourage parents to learn conventional CPR.

“You do want to be prepared to rescue them if they need that,” said Koch.

Most of the cardiac arrests occurred in infants. Those who received compressions-only CPR had a similarly low survival rate as those who did not get the potentially life-saving technique.

In most children, the underlying cause of a out of hospital cardiac arrest—which occurs when the heart stops—is a respiratory problem such as suffocation from a blanket and choking on food. The event tends to occur at home and can go unnoticed for some time.

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