Outcomes of cardiac arrest occurred in detention: a French nationwide study.

Abstract

Cardiac arrests (CA) occurring in detention settings are poorly documented. The objective was to compare the outcomes and management of CA occurring in detention facilities, comparing with those in the general population. This nationwide retrospective observational study analyzed data from the French National Cardiac Arrest Registry (RéAC) database. All adults (≥18 y.o.) for whom resuscitation was attempted by Emergency Medical Services between July 2011 and June 2025 were included. The primary outcome was 30-day survival. Secondary outcomes included return of spontaneous circulation (ROSC) and favorable neurological outcome on day 30 (defined as cerebral performance category [CPC] ≤ 2). Multivariate analyses were performed to adjust the results on baseline differences. Among 112,077 CA cases, 240 occurred in prison. Incarcerated patients were younger (median age 38, interquartile range [31-48] vs. 66 [54-77] y.o.) and more often male (219 (90.0%) vs. 77,115 (69.2%)). On day 30, 8 (3.3%) detained patients were alive vs. 6,546 (5.9%) in the general population (adjusted odds ratio (aOR) = 0.45 [0.22-0.92]). Of them, 6 (75.0%) vs. 4,927 (75.3%) presented a CPC score ≤ 2 (OR = 0.78 [0.20-3.13]). ROSC rate was also lower in detention (aOR = 0.64 [0.47-0.88]). Prison population presented lower 30-day survival rate after CA than the general population. Improved survival outcomes in this population require targeted prevention and adapted emergency response strategies.