International Incidence of Out-of-Hospital Cardiac Arrest in Children: A Systematic Review and Meta-Analysis of Epidemiological Studies.

Abstract

To determine the population-based incidence of out-of-hospital cardiac arrest involving children. We searched MEDLINE, Embase, CINAHL, and gray literature sources, from inception to March 12, 2025. We included studies and reports describing the population-based incidence of emergency medical service treated out-of-hospital cardiac arrest in children. Two reviewers independently screened studies for eligibility and extracted data. Risk of bias was assessed using the JBI Critical Appraisal Checklist for Prevalence Studies. We summarized incidence rates in the overall population and in our prespecified subgroups in a meta-analysis using a random-effects model. Four thousand seven hundred eleven studies were screened with 50 finally included in our analysis including data from 18 countries (17 high-income and one upper-middle-income). Thirty-seven thousand six hundred eighty-one cardiac arrest incidents, across a total follow-up time of 547,267,107 person-years, were included in our primary analysis. Meta-analysis generated a pooled incidence rate estimate of 5.56 out-of-hospital cardiac arrest incidents in all children in the included populations, per 100,000 person-years (95% CI, 4.54-6.58; I2 = 100%). We identified substantial variation in incidence across prespecified subgroups of etiology, presenting rhythm, and age. Included studies had an unclear overall risk of bias due to the diagnostic criteria for out-of-hospital cardiac not being commonly reported. Out-of-hospital cardiac arrest incidents affecting children reported in high-income countries are rare and the incidence is influenced by factors such as age and etiology. The lack of available data from low-middle-income countries, and the inconsistent reporting of these incidents, are limitations of this review. An international focus on standardized reporting of out-of-hospital cardiac arrest in children is required.