International incidence of out-of-hospital cardiac arrest in children: a systematic review and meta-analysis of epidemiological studies
Mellett-Smith, Adam Caunt, Michael Buckle, Alexandra Devitt, Phil Osmani, Zain Worley, Daniel Johnson, Samantha Harris, Bronwyn Brown, Terry Fothergill, Rachael
Mellett-Smith, Adam
Caunt, Michael
Buckle, Alexandra
Devitt, Phil
Osmani, Zain
Worley, Daniel
Johnson, Samantha
Harris, Bronwyn
Brown, Terry
Fothergill, Rachael
Abstract
Objectives: To determine the population-based incidence of out-of-hospital cardiac arrest involving children.
Data sources: We searched MEDLINE, Embase, CINAHL, and gray literature sources, from inception to March 12, 2025.
Study selection: We included studies and reports describing the population-based incidence of emergency medical service treated out-of-hospital cardiac arrest in children.
Data extraction: Two reviewers independently screened studies for eligibility and extracted data. Risk of bias was assessed using the JBI Critical Appraisal Checklist for Prevalence Studies.
Data synthesis: 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.
Conclusions: 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.
MIDER Authors
Date
2026-03-26
Type
Article
Subject
Resuscitation, Heart arrest, Paediatrics, Resuscitation, Cardiopulmonary resuscitation
Collections
Citation
Mellett-Smith A, Caunt M, Buckle A, Devitt P, Osmani Z, Worley D, Johnson S, Harris B, Brown T, Fothergill R, Couper K. International Incidence of Out-of-Hospital Cardiac Arrest in Children: A Systematic Review and Meta-Analysis of Epidemiological Studies. Crit Care Med. 2026 Mar 26. doi: 10.1097/CCM.0000000000007110. Epub ahead of print.
Journal / Source Title
Critical Care Medicine
DOI
10.1097/CCM.0000000000007110
PMID
41885565
Publisher
Lippincott Williams and Wilkins
Publisher’s URL
https://journals.lww.com/ccmjournal/pages/default.aspx