Decline in pediatric rescue breathing increased deaths during the pandemic

Cardiac arrest happens when the heart stops pumping blood properly, cutting off oxygen to the brain and other vital organs. In these emergencies, cardiopulmonary resuscitation (CPR) can help keep blood and oxygen moving until medical help arrives. For children, CPR usually needs both chest compressions and rescue breaths, because many cases are caused by breathing problems such as drowning, choking, or serious illness.

During the COVID-19 pandemic, fear of infection changed the way CPR was practiced. Public health guidelines for adults recommended chest compression-only CPR (CO-CPR) to minimize the risk of spreading the virus. This led to a decline in rescue breathing CPR (RB-CPR) in pediatrics with out-of-hospital cardiac arrest (OHCA) during the pandemic, as reported by previous studies. However, the impact of decline in RB-CPR on death rates remains unknown.

To unveil this, a team of researchers led by Dr. Takafumi Obara, Lecturer in the Department of Emergency, Critical Care, and Disaster Medicine, Okayama University, Japan, along with Dr. Hiromichi Naito, Dr. Kohei Tsukahara, and Dr. Atsunori Nakao from the Department of Emergency, Critical Care, and Disaster Medicine, Okayama University, Japan; and Dr. Naomi Matsumoto and Prof. Takashi Yorifuji from the Department of Epidemiology, Okayama University, analyzed data from a national registry of pediatric OHCA between 2017 and 2021. They compared the CPR given before the pandemic (2017–2019) with CPR given during it (2020–2021). This study was made available online on July 4, 2025, and was published in Volume 215 Issue 110706 of the journal Resuscitation on October 1, 2025.

Researchers found that the share of children receiving RB-CPR dropped from 33.0% before the pandemic to 21.1% during it. At the same time, CO-CPR became more common. This change was linked to worse results: children given CO-CPR were more likely to die within 30 days, especially when the cardiac arrest was caused by non-cardiac reasons such as drowning or choking.

"Pediatric cardiac arrest is never someone else's problem; it is a serious issue for our entire society. Our findings suggest that around 10 children each year may have lost their lives during the pandemic because rescue breaths weren't given," says Dr. Obara.

Based on survival rates from before the pandemic, the researchers estimated that the fall in rescue breathing may have led to about 10.7 more pediatric deaths each year during the pandemic. The drop was seen across all age groups and was very common when family members-often the first to respond-gave CPR. 

"Our study reiterating the importance of RB-CPR in pediatric OHCA, highlights the need for improving pediatric resuscitation training, raising public awareness, and ensuring access to protective tools like pocket masks," says Dr. Obara.

Overall, this study shows that the drop in rescue breathing during pediatric CPR in Japan during the COVID-19 pandemic may have cost young lives. The findings highlight the importance of clear public guidance, regular CPR training, and the use of protective tools to encourage safe rescue breathing.

"By creating a society where people can feel confident and safe when performing rescue breathing, we can prevent avoidable deaths, saving lives of children," concludes Dr. Obara.

Dr. Takafumi Obara is a Lecturer in the Department of Emergency, Critical Care, and Disaster Medicine at the Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Japan. He has authored around 75 peer-reviewed publications, focusing on pediatric emergency care, resuscitation methods, out-of-hospital cardiac arrest, and intensive care. His recent work includes studies on cardiopulmonary resuscitation techniques, extracorporeal resuscitation, and emergency medical systems. He has received multiple prestigious awards from the Okayama Medical Foundation and Kobayashi Aoitori Foundation in recognition of his contributions to emergency medicine research.