Pediatric non-traumatic out-of-hospital cardiac arrest in a high-resource metropolitan area: epidemiology and outcomes

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BACKGROUND: Pediatric out-of-hospital cardiac arrest (OHCA) is rare and often triggered by respiratory arrest. Its management is more complex than in adults, with low survival rates. In addition, European epidemiologic data on pediatric OHCA are scarce. This study analyzed the respective key figures of a west-European metropolitan area over the course of several years. METHODS: This retrospective study examined pediatric non-traumatic OHCA cases treated by the Emergency Medical Service (EMS) Vienna between 01/2019 and 12/2023, reporting on incidences, rates of return of spontaneous circulation (ROSC), survival to hospital discharge, and neurological outcomes. Logistic regression explored the relationship between outcomes and predictors, while Poisson regression was applied to analyze the pandemic lockdowns. RESULTS: During the observational period, the EMS Vienna assessed 19,067 patients (all age groups) without signs of circulation, and started cardiopulmonary resuscitation (CPR) in 110 patients <18 years (1.2/100,000 population per year, 1.4% of all CPRs). Sustained ROSC was observed in 31.8%, survival to hospital discharge in 24.5%, and a favourable neurological outcome in 17.3%. Over the years, these figures increased markedly, without a significant impact of the COVID-19 pandemic. Underlying chronic diseases were present in 46.4%. Hypoxia, both suspected in the pre-hospital setting and confirmed in-hospital, was the most common POHCA etiology. CONCLUSION: Pediatric OHCA accounts for 1.4% of all CPR cases in the metropolitan area of Vienna, with an incidence of 1.2/100,000 population/year. Survival to hospital discharge was 25%, with a favourable neurological performance in 17% of cases. Outcome improved over time. In almost half of all cases, there was a severe underlying chronic condition, and hypoxia was the most common OHCA etiology. Action plans for prevention and layperson interventions should be future goals, and a European pediatric cardiac arrest registry should be established.

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