Simplified CPR Without Mouth-to-Mouth Can Save Children Lives
January 8, 2019
Quick action is essential if someone has a sudden cardiac arrest. You might be in Target, or on a bus, or in a classroom when someone nearby just drops to the ground. Or maybe you’re boating, and you help pull a drowning victim out of the water. What do you do next?
CPR training is a great way to learn the steps, and I strongly encourage it for all parents and everyone else. But we know that many bystanders are unable to perform CPR when it’s needed. There’s panic and indecision and trying to remember what to do. To make it more possible for anyone to help, the old-school ABCs of CPR (Airway, Breathing, Circulation) have been simplified. The current recommendations for CPR in most situations consist of just a few steps:
1. Check if the victim is OK. Ask “Are you OK?” and give a little shake. If the person doesn’t respond, you need to act quickly.
2. Call for help or call 911.
3. Start pushing the middle of the chest down, over and over, fast and hard, until help arrives. If someone can bring over an automatic defibrillator, use it.
Those are all the steps. Rescue breathing has been deemphasized (it can still be used by trained people if CPR is prolonged, or in some other situations.) Checking pulses and breathing isn’t necessary. It turns out that doing something (calling for help and starting chest compressions) is better than doing nothing.
However, there’s been some concern that compression-only CPR may not be as effective for children. Kids don’t have the same kind of arrests as adults (they’re much less likely to have a heart attack, for instance.) A new study from Japan shows that compression-only CPR is probably about as effective as traditional CPR in children – and it’s far better than doing nothing.
In Japan, all out-of-hospital arrests are recorded in a tracking database. Researchers looked at all of these events from 2011 to 2012 in children from age 1 to 18 (infants less than 1 year old were excluded.) This was at a time when compression-only CPR was being promoted for use by bystanders in Japan. Data had been collected regarding whether CPR was performed, and what kind; the study authors tracked down all of the child victims to see how they were doing 1 month after their event. A good outcome was considered to be living with normal or nearly normal neurologic function.
Overall, 2,157 children experienced a cardiac arrest over two years. The most common causes were from drowning and trauma. About half of the time, no CPR was performed; among the 1,150 who received CPR, 733 had compression-only CPR. The authors were then able to compare the outcomes.
The overall chance of a favorable outcome for all of these children was 10% (which is about what we’d expect for out-of-hospital cardiac arrests.) When the causes and severity of the arrests were controlled, conventional CPR provided a 18% good outcome, compression-only CPR 16%, and no CPR 4%.
So: doing anything was far better than doing nothing at all. It’s still unclear what the “best” CPR for children should be, and further studies will likely work that out. But we now know that simple, compression-only CPR is about as good as full-scale, mouth-to-mouth plus compression CPR. If you’re not sure what to do, just push on that chest, fast and hard, until help arrives.
The best way to learn CPR is a hands-on, in-person course with a qualified instructor. There are some good alternatives if you’re in a hurry. The CPR Anytime course can teach you the basics online in about 20 minutes. If you don’t have the time for that, watch this brief video about compression-only CPR. (https://www.youtube.com/watch?v=c7Q1s7ppSwc)
Remember, you don’t have to remember everything, and you don’t need to be perfect. Call for help, and then push – hard and fast. You can save a life.
Roy Benaroch, MD, FAAP is an Associate Adjunct Professor of Pediatrics with Emory University. He has produced several courses exploring medical cases for laymen in his "Medical School for Everyone" lectures, available from The Great Courses, and has also written books for parents and chapters in medical textbooks. He is also on the Board of Directors of The Children's Care Network, one of the largest clinically integrated pediatric care networks in the country. Dr. Benaroch practices general pediatrics near Atlanta, GA.