BACKGROUND: Bystander cardiopulmonary resuscitation (CPR) is a key link in the chain of survival for out-of-hospital cardiac arrest (OHCA). While bystander CPR initiated within 10 minutes is associated with improved survival in adults, this association in children is unknown. We examined the association between time to bystander CPR initiation and survival outcomes in children with OHCA. METHODS: We conducted a retrospective cohort study in the United States using the Cardiac Arrest Registry to Enhance Survival, including pediatric (<18 years) patients with nontraumatic OHCA from 2013 to 2023. Time to bystander CPR was estimated from the 9-1-1 call timestamp and bystander report of time of CPR initiation. The primary outcome was survival to hospital discharge; the secondary outcome was favorable neurological survival. Multivariable hierarchical logistic regression models evaluated the association between time to bystander CPR and survival outcomes, adjusted for demographic and cardiac arrest characteristics. RESULTS: Of 10 991 pediatric OHCAs (mean SD age, 4.5 5.8 years; 40.9% female), 5446 (49.5%) received bystander CPR, whereas 5545 (50.5%) received CPR after first responder arrival. Median time to bystander CPR was 3.0 minutes (IQR, 1.0-9.0). Overall, 1677 (15.3%) survived to discharge, and 1420 (12.9%) had favorable neurological survival. As compared with patients without bystander CPR, there was a graded inverse relationship between time to bystander CPR and survival to discharge during the first 5 minutes after initiation (0-1 minute: adjusted odds ratio, 1.91 95% CI, 1.65-2.20; 2-3 minutes: adjusted odds ratio, 1.98 95% CI, 1.63-2.40; 4-5 minutes: adjusted odds ratio, 1.37 95% CI, 1.09-1.72). A similar pattern was observed for the outcome of favorable neurological survival, with ≈2-fold higher odds when CPR was initiated within 3 minutes and no benefit when initiated after 5 minutes. CONCLUSIONS: In pediatric OHCA, earlier bystander CPR initiation was associated with improved survival outcomes, with the greatest benefit observed within the first 5 minutes. These findings underscore the importance of early CPR initiation and the need for continued efforts to enhance bystander response.
Jawad et al. (Mon,) studied this question.