We appreciate the comments by Mr. Rottenberg concerning our report of the prevalence and outcomes of cardiopulmonary resuscitation (CPR) in hospitalized pediatric patients (1). Although we acknowledge the literature cited in the argument for alternative methods of CPR in children (2), we do not feel that the findings of our recent study support or refute this notion. We found that children 1 year of age or older were more likely to die following CPR than their younger counterparts (68% vs. 44%), but it is not clear that the techniques of CPR used contributed to this difference (1). It is important to note, as we did in our article, that the data were obtained from an administrative database, and there are no data within the database on the quality or methods of CPR. Any suggestion that one technique of CPR would have led to different outcomes over an alternative technique is purely speculative. We speculate that the data records in the Kid’s Inpatient Database likely include a great number of neonates that underwent CPR for apnea and bradycardia events (which are known to be responsive to stimulation, including chest compressions). These events related to apnea of prematurity are common in neonatology units and differ greatly from cardiac arrest in older children secondary to other etiologies (e.g., septic shock and cardiogenic shock).
Interestingly, our findings contradicted what has been reported in out-of-hospital pediatric cardiac arrest and are similar to previous studies of inpatient cardiac arrests (2, 3). This age-dependent difference in outcome from in-hospital and out-of-hospital cardiac arrests may be secondary to many factors including delayed recognition of cardiopulmonary events in infants out of the hospital compared with hospitalized infants who are more closely monitored, etiologies of cardiac arrest and comorbidities, quality of CPR, and possibly techniques of CPR (3, 4). Although one can speculate that alternative techniques of CPR would lead to improved outcomes, future studies examining the effects of CPR methods in children of varying ages and sizes are needed to determine whether specifically targeted, age- and size-dependent CPR strategies are justified in children.