International Incidence of Out-of-Hospital Cardiac Arrest in Children: A Systematic Review and Meta-Analysis of Epidemiological Studies.
Critical care medicine · 2026-03-26 · Meta-analysis
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.