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J Am Heart Assoc. 2019 Jul 16;8(14):e012637. doi: 10.1161/JAHA.119.012637. Epub 2019 Jul 10.

Race/Ethnicity and Neighborhood Characteristics Are Associated With Bystander Cardiopulmonary Resuscitation in Pediatric Out-of-Hospital Cardiac Arrest in the United States: A Study From CARES.

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1 The Cardiac Center Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine Philadelphia PA.
5 Department of Anesthesiology and Critical Care Medicine Children's Hospital of Philadelphia Perelman School of Medicine at the University of Pennsylvania Philadelphia PA.
2 Healthcare Analytics Unit of Center for Pediatric Clinical Effectiveness and PolicyLab Children's Hospital of Philadelphia PA.
3 Children's Hospital of Los Angeles Keck School of Medicine University of Southern California Los Angeles CA.
4 Department of Emergency Medicine Emory University Atlanta GA.
6 Sky Ridge Medical Center Lone Tree CO.
7 Division of Emergency Medicine University of Texas Health Science Center Houston TX.
8 Leonard Davis Institute The University of Pennsylvania Philadelphia PA.


Background Whether racial and neighborhood characteristics are associated with bystander cardiopulmonary resuscitation ( BCPR ) in pediatric out-of-hospital cardiac arrest ( OHCA ) is unknown. Methods and Results An analysis was conducted of CARES (Cardiac Arrest Registry to Enhance Survival) for pediatric nontraumatic OHCA s from 2013 to 2017. An index (range, 0-4) was created for each arrest based on neighborhood characteristics associated with low BCPR (>80% black; >10% unemployment; <80% high school; median income, <$50 000). The primary outcome was BCPR . BCPR occurred in 3399 of 7086 OHCA s (48%). Compared with white children, BCPR was less likely in other races/ethnicities (black: adjusted odds ratio [ aOR ], 0.59; 95% CI , 0.52-0.68; Hispanic: aOR , 0.78; 95% CI , 0.66-0.94; and other: aOR , 0.54; 95% CI , 0.40-0.72). Compared with arrests in neighborhoods with an index score of 0, BCPR occurred less commonly for arrests with an index score of 1 ( aOR , 0.80; 95% CI , 0.70-0.91), 2 ( aOR , 0.75; 95% CI , 0.65-0.86), 3 ( aOR , 0.52; 95% CI , 0.45-0.61), and 4 ( aOR , 0.46; 95% CI , 0.36-0.59). Black children had an incrementally lower likelihood of BCPR with increasing index score while white children had an overall similar likelihood at most scores. Black children with an index of 4 were approximately half as likely to receive BCPR compared with white children with a score of 0. Conclusions Racial and neighborhood characteristics are associated with BCPR in pediatric OHCA . Targeted CPR training for nonwhite, low-education, and low-income neighborhoods may increase BCPR and improve pediatric OHCA outcomes.


bystander cardiopulmonary resuscitation; children; out‐of‐hospital cardiac arrest; pediatric; race/ethnicity; socioeconomic status

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