Incidence, outcomes, and temporal trends of pediatric in-hospital cardiac arrest in Japan: a nationwide study.

Abstract

To report the incidence, outcomes, resuscitation characteristics, and temporal trends of pediatric in-hospital cardiac arrest in Japan using nationwide administrative data. Using a national administrative inpatient database from 2011 to 2022, we identified eligible admissions aged <18 years. In-hospital cardiac arrest (IHCA) was operationally defined as a hospitalization with recorded chest compressions. All eligible admissions served as the denominator for IHCA incidence calculations, whereas admissions with out-of-hospital cardiac arrest were excluded when identifying IHCA cases. Among 7,117,481 eligible admissions, 6962 hospitalizations with recorded chest compressions were identified as IHCA. The overall incidence of IHCA per 1000 admissions was 0.98 and decreased from 1.03 in 2011 to 0.86 in 2022 (P for trend = 0.009). Among IHCA hospitalizations, the median age was 1 year (interquartile range [IQR], 0-7), and 55.8% were male. The median recorded duration of chest compressions was 23 min (IQR 7-50). Adrenaline administration and tracheal intubation were recorded on the same calendar day as chest compressions in 71.0% and 61.7%, respectively. Overall survival to hospital discharge was 30.6% and increased from 25.8% in 2011 to 29.6% in 2022 (P for trend = 0.006). Among hospitals with IHCA, 70-80% managed only one or two cases annually. Using an administrative chest compression procedure code, we identified a declining incidence of IHCA and improving survival in Japan. These findings require cautious interpretation because case ascertainment was code-based. A national registry is needed to validate administrative case identification and better characterize resuscitation processes and outcomes.