Is It Time to Stop Teaching Bystanders Ventilation as Part of Pediatric Cardiopulmonary Resuscitation?
Bibliographic record
Abstract
he 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 cardiac-based) OHCA, especially by those rescuers untrained in conventional CPR. 4 To date, outcomes after bystander CC-CPR have been comparable to those after conventional CPR in adults, as supported by data from not only observational studies but also several randomized, controlled trials.5 CC-CPR might be acceptable for use in adults, but what about children?As opposed to the arrhythmic arrests commonly seen in adults, pediatric OHCA is often respiratory in origin, supporting the concept that ventilation may be more critical in pediatric resuscitation.6 ILCOR's 2015 treatment recommendations encouraged rescuers to provide ventilation and chest compressions for pediatric OHCA victims 1 and were based on pooled data from 2 studies from the All-Japan Utstein Registry, showing that the use of CC-CPR compared with conventional CPR was associated with worse 30-day intact neurological survival (risk ratio, 0.46; 95% confidence interval [CI], 0.34-0.62).7,8 Of these 2 studies, the Kitamura study provided more detailed analysis of subgroup outcomes based on the type of cardiac arrest, includ-is it time to Stop teaching Bystanders Ventilation as Part of Pediatric Cardiopulmonary resuscitation?
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.033 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.005 | 0.003 |
| Scholarly communication | 0.004 | 0.006 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.062 | 0.053 |
| Insufficient payload (model declined to judge) | 0.007 | 0.004 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".