Initiating cardiopulmonary resuscitation (CPR) within the first five minutes after a child's cardiac arrest can nearly double their chances of survival, according to preliminary research presented at the American Heart Association’s Resuscitation Science Symposium 2025. The study, analyzing data from more than 10,000 children in the Cardiac Arrest Registry to Enhance Survival (CARES), found that the benefit of bystander CPR drops sharply after five minutes, a time window half that observed in adults.
Cardiac arrest occurs when the heart's electrical system malfunctions, stopping blood flow to vital organs. For children, CPR involves cycles of 30 chest compressions at 100-120 compressions per minute followed by two breaths. While adult studies show survival benefits when CPR is started within 10 minutes, the optimal window for children remained unclear until now.
The research team, led by Mohammad Abdel Jawad, M.D., M.S., a research fellow at the University of Missouri-Kansas City and Saint Luke’s Mid America Heart Institute, examined the timing of lay rescuer CPR—performed by family, friends, or strangers before emergency medical services arrive. They found that children who received CPR within one minute had 91% higher odds of survival; within two to three minutes, 98%; and within four to five minutes, 37%. However, survival odds decreased when CPR was delayed beyond five minutes: 24% lower at six to seven minutes, 33% lower at eight to nine minutes, and 41% lower at 10 minutes or more. Similar patterns emerged for favorable brain function at discharge.
“If a child’s heart suddenly stops, every second counts. Starting CPR immediately can nearly double their chances of survival,” Jawad said. “We found the time window is even more critical in children, so it is imperative to emphasize starting CPR as soon as possible after a cardiac arrest.” The study underscores the importance of increasing the number of lay rescuers trained in CPR, especially among parents, teachers, and coaches.
The analysis reviewed 10,991 out-of-hospital pediatric cardiac arrests, of which about half (5,446) received bystander CPR. The median time to lay rescuer CPR was three minutes. Overall, more than 15% of children survived to hospital discharge, and nearly 13% had favorable brain function, with better outcomes when CPR was initiated within five minutes.
Dianne Atkins, M.D., FAHA, FAAP, volunteer past-chair of the American Heart Association Emergency Cardiovascular Care Committee, commented: “This research supports the fact that in a cardiac emergency, every second counts. Science shows that when lay rescuers step in and begin CPR within the first few minutes, survival rates can more than double, and the chances of preserving brain function dramatically increase.”
The study is part of the American Heart Association’s Nation of Lifesavers™ movement, aiming to double cardiac arrest survival by 2030. According to American Heart Association data, 9 out of 10 people who experience cardiac arrest outside a hospital die, partly because immediate CPR is not performed more than half the time. The findings highlight the need for broader CPR training in schools and communities.
Limitations of the study include reliance on EMS reports for timing, which may not be exact. Future research could focus on improving dispatcher instructions and implementing CPR training during well-child visits. The abstract is considered preliminary until published in a peer-reviewed journal.
