Chest-compression-only versus conventional cardiopulmonary resuscitation by bystanders for children with out-of-hospital cardiac arrest: A systematic review and meta-analysis

Background: For children with out-of-hospital cardiac arrest, previous observational studies regarding chest-compression-only CPR (CC-CPR) versus conventional CPR yielded inconsistent results. We aimed to summarize the current evidence and compare the outcomes after CC-CPR with those after conventional CPR by bystanders in children with out-of-hospital cardiac arrest. Methods: Observational studies that compared CC-CPR to conventional CPR for children with out-of-hospital cardiac arrest were identified through systematic searches of three databases (PubMed, EMBASE, and the Cochrane Library). The primary outcome was 30-day survival after hospital discharge. STATA 11.0 was used for data analysis. Results: Five studies with 14,427 participants were included. Pooled results indicated that children who received conventional CPR had a higher 30-day survival than those who received CC-CPR (odds ratio, 1.49; 95% confidence interval [CI], 1.27-1.74). Moreover, conventional CPR led to a higher 30-day neurologically intact survival compared to CC-CPR (odds ratio, 1.63; 95% CI, 1.30-2.04). Subgroup analyses showed that the higher survival associated with conventional CPR was only significant in children who had cardiac arrest with non-cardiac causes (odds ratio, 1.77; 95% CI, 1.30-2.40). Conclusions: Children who receive conventional CPR for out-of-hospital cardiac arrest may have better outcomes than those who receive CC-CPR. Due to the limited number of studies and lack of randomized trials included in this meta-analysis, more evidence is needed to confirm our findings.