News

Article from Guardian 3 March 2010:

Most children who are resuscitated after a cardiac arrest do better if given mouth-to-mouth resuscitation as well as chest compressions, a study in Japan discovered. However, any type of resuscitation was better than none at all.

What do we know already?

Your body relies on your heart to pump oxygen-rich blood to your muscles and organs. Without oxygen, cells start to die. This can cause brain damage, as well as damage to other parts of your body.

If someone has a cardiac arrest, it means their heart stops pumping. This could be because they've had a heart attack, or for other reasons, such as having a severe asthma attack, a drugs overdose, or inhaling smoke in a fire.

Cardiopulmonary resuscitation (CPR) aims to keep someone alive by giving their heart and lungs some outside help. Chest compressions aim to pump blood around the body from the heart, keeping brain cells alive until the heart starts beating properly again. Artificial respiration - the so-called 'kiss of life' where you breathe to inflate someone's lungs through their nose or mouth - keeps their blood oxygenated.

The trouble is, many people are worried about doing resuscitation properly, and research shows that people don't like the thought of giving mouth-to-mouth. So, when someone has a cardiac arrest outside of a hospital, often nobody volunteers to do resuscitation. To get round this problem, doctors have been encouraging people to give chest compressions, even if they don't want to do mouth-to-mouth.

Studies on adults with cardiac arrest have shown that just doing chest compressions can work about as well. But there's little research looking at whether the same is true for children.

What does the new study say?

The study looked at what happened to more than 5,000 Japanese children who'd had a cardiac arrest outside hospital, for any reason. The researchers looked to see how likely they were to have survived without serious brain damage.

They found:

Children who'd been given any resuscitation before the emergency services arrived did better. Overall, 4.5 percent survived without brain damage compared with 1.9 percent who'd not had resuscitation.
Overall, children did better if they'd had conventional resuscitation, including chest compressions and artificial respiration. For children who'd had a cardiac arrest for external reasons (not connected to a heart problem), 7.2 percent survived with conventional resuscitation, compared with 1.9 percent who had just chest compressions.
But children who'd had a cardiac arrest because of a heart problem did just as well, whether they had chest compressions alone, or both chest compressions and artificial respiration.

How reliable are the findings?

The study looked at the medical records of a large number of children. The researchers took account as far as possible of the other factors that could have affected the children's survival, such as their state of health and how quickly the emergency services arrived to take over resuscitation. It's possible, though, that people who gave chest compressions and artificial respiration together were more likely to have been trained in resuscitation than people who just gave chest compressions. That might mean their technique overall was better.

Where does the study come from?

The study was done by researchers at several universities in Japan, and published in The Lancet, a medical journal owned by Elsevier. It was paid for by the Fire and Disaster Management Agency and the Ministry of Education, Culture, Sports, Science and Technology (Japan).

What does this mean for me?

Knowing how to perform CPR for someone who isn't breathing and whose heart has stopped is a useful skill to have. If possible, especially when treating children, you should give artificial respiration as well as chest compressions.

The Red Cross gives these guidelines on giving resuscitation to a child aged over 1 year:

Open the airway by placing one hand on their forehead and gently tilting the head back and lifting the chin. Remove any visible obstructions from the mouth and nose.
Pinch the child's nose. Place your mouth over the child's mouth and attempt five initial rescue breaths.
Place your hands on the centre of their chest and, with the heel of your hand, press down one third of the depth of the chest using one or two hands. After every 30 chest compressions give two rescue breaths.
Continue with cycles of 30 chest compressions and two rescue breaths until emergency help arrives or the person begins to breathe normally.

The guidelines say that, if you are unable or unwilling to give rescue breaths, you should give chest compressions alone.

What should I do now?

It's best to train in first aid so you know how to give CPR properly. To find out more about first aid training, see http://www.redcross.org.uk/TLC.asp?id=76599.

From:

Kitamura T, Iwami T, Kawamura T, et al. 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. Lancet. Published online 3 March 2010.

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