The Epidemiology of Paediatric Out-of-Hospital Cardiac Arrest in Australia and New Zealand: A Report from The Australasian Resuscitation Outcomes Consortium Epistry (Aus-ROC).

BACKGROUND

This first epidemiological study of paediatric out-of-hospital cardiac arrest (pOHCA) across Australia and New Zealand explores the incidence, patient and event characteristics, both overall and by developmental age groups, and examines factors associated with outcomes.

METHODS

All pOHCAs (aged <18 years) attended by emergency medical services (EMS) in Australia and New Zealand from 2017 to 2023 were included. Crude incidence rates (per 100,000 person-years) were calculated for EMS-attended and EMS-treated cases. Logistic regression models were used to identify associations between patient and arrest characteristics and survival (event and 30-day/hospital discharge).

RESULTS

EMS attended 4,779 cases and treated 3,139 (65.7%). Incidence rates for EMS-attended and EMS-treated cases were 10.1 and 6.6, respectively; with a bimodal age distribution peaking in infants (65.4) and adolescents (11.4). Most EMS-attended cases were unwitnessed (66.9%), of medical origin (60.1%), had initial non-shockable rhythms (91.1%), occurred in private residences (74.3%), and received bystander cardiopulmonary resuscitation (62.7%). Few (1.6%) received bystander defibrillation. Arrest characteristics varied widely between age groups. Survival to 30-days/hospital discharge in EMS-treated cases was 10.0% (highest in late childhood [15.4%] and lowest in infants [7.9%]). Multivariable analysis identified that increasing age was positively associated with event survival, whilst bystander-witnessed arrest, initial shockable rhythm, arrest aetiology, and EMS response time were significant predictors of short and long-term survival.

CONCLUSION

The incidence, patient characteristics, and survival outcomes of pOHCA in our region differ significantly by age groups. Age- and context-specific prevention and resuscitation strategies are essential for reducing the burden and improving survival outcomes.