<p><strong>Importance: </strong>There are few data on the prevalence or outcome of bystander cardiopulmonary resuscitation (BCPR) in children 18 years and younger.</p>

<p><strong>Objective: </strong>To characterize BCPR in pediatric out-of-hospital cardiac arrests (OHCAs).</p>

<p><strong>Design, Setting, and Participants: </strong>This analysis of the Cardiac Arrest Registry to Enhance Survival database investigated nontraumatic OHCAs in children 18 years and younger from January 2013 through December 2015.</p>

<p><strong>Exposures: </strong>Bystander CPR, which included conventional CPR and compression-only CPR.</p>

<p><strong>Main Outcomes and Measures: </strong>Overall survival and neurologically favorable survival, defined as a Cerebral Performance Category score of 1 or 2, at the time of hospital discharge.</p>

<p><strong>Results: </strong>Of the 3900 children younger than 18 years with OHCA, 2317 (59.4%) were infants, 2346 (60.2%) were female, and 3595 (92.2%) had nonshockable rhythms. Bystander CPR was performed on 1814 children (46.5%) and was more common for white children (687 of 1221 [56.3%]) compared with African American children (447 of 1134 [39.4%]) and Hispanic children (197 of 455 [43.3%]) (P &lt; .001). Overall survival and neurologically favorable survival were 11.3% (440 of 3900) and 9.1% (354 of 3900), respectively. On multivariable analysis, BCPR was independently associated with improved overall survival (adjusted proportion, 13.2%; 95% CI, 11.81-14.58; adjusted odds ratio, 1.57; 95% CI, 1.25-1.96) and neurologically favorable survival (adjusted proportion, 10.3%; 95% CI, 9.10-11.54; adjusted odds ratio, 1.50; 95% CI, 1.21-1.98) compared with no BCPR (overall survival: adjusted proportion, 9.5%; 95% CI, 8.28-10.69; neurologically favorable survival: adjusted proportion, 7.59%; 95% CI, 6.50-8.68). For those with data on type of BCPR, 697 of 1411 (49.4%) received conventional CPR and 714 of 1411 (50.6%) received compression-only CPR. On multivariable analysis, only conventional CPR (adjusted proportion, 12.89%; 95% CI, 10.69-15.09; adjusted odds ratio, 2.06; 95% CI, 1.51-2.79) was associated with improved neurologically favorable survival compared with no BCPR (adjusted proportion, 9.59%; 95% CI, 6.45-8.61). There was a significant interaction of BCPR with age. Among infants, conventional BCPR was associated with improved overall survival and neurologically favorable survival while compression-only CPR had similar outcomes to no BCPR.</p>

<p><strong>Conclusions and Relevance: </strong>Bystander CPR is associated with improved outcomes in pediatric OHCAs. Improving the provision of BCPR in minority communities and increasing the use of conventional BCPR may improve outcomes for children with OHCA.</p>

<p><strong>OBJECTIVES: </strong>Hyperglycemia is common and may be a risk factor for nosocomial infections, including central catheter-associated bloodstream infections in critically ill children. It is unknown whether hyperglycemia at the time of acquiring central catheter-associated bloodstream infections in pediatric critical illness is associated with worse outcomes. We hypothesized that hyperglycemia (blood glucose concentration &gt; 126 mg/dL [&gt; 7 mmol/L]) at the time of acquiring central catheter-associated bloodstream infections (from 4 d prior to the day of first positive blood culture, i.e., central catheter-associated bloodstream infections) in critically ill children is common and associated with ICU mortality.</p>

<p><strong>DESIGN: </strong>Retrospective observational cohort study.</p>

<p><strong>SETTING: </strong>Fifty-five-bed PICU and 26-bed cardiac ICU at an academic freestanding children's hospital.</p>

<p><strong>PATIENTS: </strong>One hundred sixteen consecutively admitted critically ill children from January 1, 2008, to June 30, 2012, who were 0-21 years with central catheter-associated bloodstream infections were included. We excluded children with diabetes mellitus, metabolic disorders, and those with a "do not attempt resuscitation" order.</p>

<p><strong>INTERVENTIONS: </strong>None.</p>

<p><strong>MEASUREMENTS AND MAIN RESULTS: </strong>The study cohort had an overall ICU mortality of 23%, with 48% of subjects developing hyperglycemia at the time of acquiring central catheter-associated bloodstream infections. Compared with survivors, nonsurvivors experienced more hyperglycemia both at the time of acquiring central catheter-associated bloodstream infections and subsequently. Median blood glucose at the time of acquiring central catheter-associated bloodstream infections was higher in nonsurvivors compared with survivors (139.5 mg/dL [7.7 mmol/L] vs 111 mg/dL [6.2 mmol/L]; p &lt; 0.001) with 70% of nonsurvivors experiencing blood glucose greater than 126 mg/dL (&gt; 7 mmol/L) during the 7 days following central catheter-associated bloodstream infections (in comparison to 45% of survivors; p = 0.03). After controlling for severity of illness and interventions, hyperglycemia at the time of acquiring central catheter-associated bloodstream infections was independently associated with ICU mortality (adjusted odds ratio, 1.9; 95% CI, 1.1-6.4; p = 0.03), in addition to other risk factors for ICU mortality (vasopressor use and severity of organ dysfunction).</p>

<p><strong>CONCLUSIONS: </strong>Hyperglycemia at the time of acquiring central catheter-associated bloodstream infections is common and associated with ICU mortality in critically ill children. Strategies to monitor and control blood glucose to avoid hyperglycemia may improve outcomes in critically ill children experiencing central catheter-associated bloodstream infections.</p>