Reduced Use of Rescue Breaths in Pediatric CPR During COVID-19 Associated with Increased Child Mortality

The COVID-19 pandemic has brought significant changes to emergency response protocols, notably affecting pediatric cardiopulmonary resuscitation (CPR). Traditionally, successful out-of-hospital cardiac arrest (OHCA) in children relies heavily on both chest compressions and rescue breaths, especially since many cases stem from breathing emergencies like drowning, choking, or illness. However, fears of infection led to a shift towards chest compression-only CPR (CO-CPR) during the pandemic, reducing the frequency of rescue breathing efforts.

A comprehensive study led by Dr. Takafumi Obara from Okayama University analyzed data from Japan's national pediatric OHCA registry between 2017 and 2021. The researchers compared CPR interventions administered before the pandemic (2017-2019) and during it (2020-2021). Their findings revealed a notable decline in rescue breathing: the share of children receiving rescue breaths decreased from 33.0% pre-pandemic to just 21.1% during the pandemic, with an accompanying increase in the use of chest compression-only CPR.

This shift had serious consequences. Children who received only chest compressions were found to have a higher likelihood of death within 30 days of the arrest, especially in cases caused by non-cardiac reasons like drowning or choking. The study estimates that this decline in rescue breathing may have contributed to approximately 10.7 additional pediatric deaths annually during the pandemic.

According to Dr. Obara, pediatric cardiac arrest is a critical issue that impacts society as a whole. He emphasizes that over ten children per year might have unnecessarily lost their lives due to the avoidance of rescue breaths during emergencies. The findings underscore the importance of public education on effective pediatric CPR, including rescue breathing, and the need for accessible protective tools like pocket masks to ensure safe and effective resuscitation efforts.

Overall, this research highlights the crucial role of rescue breathing in pediatric emergencies and suggests that public health initiatives should focus on reinforcing proper CPR techniques. Ensuring confidence and safety while performing rescue breathing could prevent avoidable deaths and save many young lives, even amid ongoing health crises.

For more detailed insights, see the full study published in the journal Resuscitation (doi:10.1016/j.resuscitation.2025.110706).