Is It Time to Stop Teaching Bystanders Ventilation as Part of Pediatric Cardiopulmonary Resuscitation?

Articles, see p 2046 and p 2060 The International Liaison Committee on Resuscitation (ILCOR) is made up of the world’s major resuscitation councils. Part of its function is to periodically perform systematic reviews of resuscitation topics that are the foundation for council-specific resuscitation guidelines for basic and advanced life support for both adults and children. ILCOR’s Pediatric Task Force regularly reviews pediatric resuscitation science to generate evidence-informed treatment recommendations to guide the care of pediatric victims of out-of-hospital cardiac arrest (OHCA).1 ILCOR’s ability to do so has historically been limited by the number and size of the pediatric studies available for its systematic reviews. For more than a decade, the All-Japan Utstein Registry of its Fire and Disaster Management Agency has prospectively collected adult and pediatric OHCA data from across Japan. The registry has an impressive history of accurate and complete data capture, with no missing, incomplete, or inconsistent data for patients included in many of its studies.2 This registry has allowed observational study of many important clinical questions. Two such questions are addressed in the 2 articles from this registry published in this issue of Circulation : What is the outcome of children with OHCA resuscitated by lay rescuers using chest compression–only cardiopulmonary resuscitation (CC-CPR) compared with conventional CPR (with ventilation)2? And what are the associations between the duration of CPR for pediatric OHCA and patient outcomes.3 Bystander CPR rates in many parts of the world remain low, and the inability or unwillingness to provide ventilation as part of conventional CPR has been one of the often-cited explanations. This, coupled with the greater complexity associated with teaching lay rescuers ventilation and the interruptions to chest compressions to give breaths, has led guidelines and training organizations to encourage CC-CPR by lay rescuers for adult (primarily …