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Background: Bystander cardiopulmonary resuscitation (CPR) is a key link in the chain of survival for out-of-hospital cardiac arrest (OHCA). In adults, bystander CPR administered at under 10 minutes is associated with better outcomes, but this relationship in children is unclear. Objective: Examine the association between time to bystander CPR initiation and survival outcomes in children. Methods: We conducted a retrospective cohort study of pediatric (<18 years) patients with OHCA using data from the Cardiac Arrest Registry to Enhance Survival. The primary outcome was survival to hospital discharge. Secondary outcome was favorable neurological survival. Multivariable hierarchical logistic regression models evaluated the association between time to bystander CPR and survival outcomes, adjusting for demographic and cardiac arrest characteristics. Results: Among 10,965 pediatric OHCA patients, 5,446 (49.5%) received bystander CPR. Median time to bystander CPR was 3.0 minutes (IQR:1.0-9.0). Overall, 1,677 (15.3%) survived to hospital discharge, and 1,420 (12.9%) had favorable neurological survival. As compared to patients without bystander CPR, there was a graded inverse relationship between time to bystander CPR and survival to discharge during the first 5 minutes of initiation (0-1 minute: adjusted odds ratio [aOR], 1.91 [95% CI: 1.65–2.20]; 2-3 minutes: aOR, 1.98 [1.63-2.40]; 4-5 minutes: aOR, 1.37 [1.09-1.72]; 6-7 minutes: aOR, 0.76 [0.51-1.13]; 8-9 minutes: aOR, 0.67 [0.41-1.08]; ≥ 10 minutes: aOR, 0.59 [0.46-0.77], Figure ). A similar pattern was observed between time to bystander CPR and favorable neurological survival. Conclusion: In children with OHCA, there was a graded inverse relationship between time to bystander CPR and survival outcomes, with a survival benefit when bystander CPR was initiated during the first 5 minutes. These findings underscore the critical importance of early CPR initiation and the need for continued efforts to enhance bystander response.