Abstract P3154: Out-Of-Hospital Pediatric Cardiac Arrest, Survival, And Associated Factors – A Systematic Review And Meta-Analysis

Abstract

Introduction: Pediatric out-of-hospital cardiac arrest (OHCA) is associated with poor survival and neurological outcomes. Large variations in the incidence and survival have been reported across nations therefore, there is a need to systematically summarize the published data to report pooled survival and analyze the factors associated with survival. Methods: We conducted a comprehensive review of published literature using data from January 1, 2005, to June 30, 2023, including any observational or interventional study of OHCA in children that reported at least one survival outcome, confirmed to Utstein criteria for population selection and had a sample size of at least 50 patients. We separately looked at studies reporting all EMS (emergency medical service) assessed and treated OHCAs and those reporting only patients surviving to hospital admission following OHCA. We excluded studies focusing on specialized populations, duplicate data from the same registry, reporting combined data on in-hospital and out-of-hospital arrests or children and adults, and where data could not be separated. We used Der Simonian-Laird (DL) random-effects model to pool the results. Results: We included 34 studies with data from 69,834 pediatric OHCAs assimilating more than 20 years of global data. Pooled survival and neurological outcome for EMS-assessed and treated OHCAs were 13% (95% CI: 11% to 15%) and 6% (95% CI: 5% to 8%) respectively. For the admitted patients, survival rates were 46% (95% CI: 40% to 53%) and 28% (95% CI: 19% to 37%) respectively. Survival was highest for Europe, followed by North America, Asia and Australia. Predictors of improved survival included witnessed arrest, shockable rhythm, public location of arrest, bystander CPR, and age > 1 year. Having a cardiac cause of arrest was associated with worse survival. High heterogeneity was observed for pooled survival and most of the predictors. The I 2 was reduced to 0% when reporting region-specific results. Conclusions: Survival for pediatric OHCA patients has improved over the years but remains low. Geographical disparities exist owing to differences in pre-hospital care organization. The standardized Utstein criteria need to be widely implemented to improve the comparison of global estimates.