Any infant or child who goes into cardiac or respiratory arrest faces daunting odds for survival and long-term recovery. But statistics show that location matters: outcomes are considerably worse for children who experience cardiac or respiratory arrest outside of the hospital setting. Compared to a roughly 40% survival rate for in-hospital cardiac arrest (IHCA), pediatric out-of-hospital cardiac arrest (OHCA) victims have at best only about a 10% chance of survival.1-3
In this article, we dive deeper into the discrepancy between pediatric IHCA and OHCA survival rates. The difference is far from minor, so what’s driving it? And most importantly, what can be done to improve pediatric OHCA outcomes and help close the gap? Keep reading to find out.
Understanding low pediatric OHCA survival rates
To start, let’s take a closer look at why pediatric OHCA survival rates lag behind IHCA.
Setting & response time
In part, the discrepancy can be explained by a basic difference between IHCA and OHCA: the patient’s proximity to medical care.
An OHCA victim can go into cardiac or respiratory arrest anywhere: at home, at work or school, at a sporting event, etc. How rapidly they receive care depends on a number of variables in their environment: who witnesses the arrest and how quickly they contact 911, whether and how soon a bystander begins cardiopulmonary resuscitation (CPR), and Emergency Medical Services response time, to name a few.
By contrast, an IHCA victim is often only feet away from a defibrillator, other emergency equipment and medications, and experienced staff trained to respond to the event. Of course, these factors don’t guarantee a favorable outcome. But since every second counts in cardiac arrest, having immediate access to trained medical personnel and equipment offers an obvious advantage. This is true for all patients — children as well as adults.
Proximity to medical care and timely response are critical regardless of the patient’s age, but it’s also worth considering specific challenges that the pediatric population faces in OHCA.
- Lack of awareness of pediatric cardiac arrest: Cardiac arrest can happen to anyone, but the public generally does not expect it to occur in young children or infants.4 This means that bystanders are less prepared to recognize and respond quickly when it does.
- Bystander hesitancy: Within the pediatric population, the largest group of OHCA victims is under one year of age. This group also has one of the lowest rates of bystander CPR, likely due to fear of performing CPR incorrectly on a young child.5 This hesitation — while often understandable given bystanders’ varying knowledge, background, and training — comes at a cost. If pediatric victims received compressions sooner during the arrest, survival rates and neurologic outcomes would likely improve.
Improving pediatric OHCA outcomes
So what can be done to improve pediatric OHCA outcomes and help close the gap?
Educate & spread the word
No one can control when or where an infant or child goes into cardiac arrest — or who happens to witness the event when it occurs. But since pediatric OHCA victims rely heavily on bystander intervention, it’s important to better inform the public and equip bystanders with the knowledge and confidence to respond.
Training programs in Basic Life Support (BLS)/CPR give the public practical, hands-on experience with performing CPR and responding efficiently in an emergency. These kinds of programs are essential for anyone who spends significant time around infants and children: parents/caregivers and other family members, teachers and daycare workers, coaches and volunteers, and more.
Training is the most effective way to empower bystanders to respond, particularly since the fear of “doing more harm than good” so often deters bystanders from performing life-saving CPR on kids. For more strategies on increasing access to BLS training, check out our blog post here.
Public service announcements (for example, at sporting events)4 can help amplify the message that cardiac arrest isn’t limited to adults — and what to do when it happens to a child or infant. For example, knowing that a 911 operator can provide CPR coaching over the phone — known as telecommunicator CPR (T-CPR) — can help hesitant bystanders feel more comfortable getting involved. That’s why it is so important to get the word out to as many people as possible.
Collect & analyze registry data
Participation in data registries is critical to improving cardiac arrest outcomes. Programs like Cardiac Arrest Registry to Enhance Survival (CARES), currently the largest OHCA registry in the United States, help communities to:
- Capture data on each OHCA event
- Analyze that data to monitor quality of care and better understand factors like EMS response times, bystander CPR and T-CPR, etc.
- Compare response and outcomes within a state/community to national benchmarks
Although CARES has grown steadily since its inception in 2005, it’s still not representative of all states/communities.6 Increased participation would undoubtedly help improve OHCA outcomes overall. And from a pediatric standpoint, it could also help communities isolate and analyze pediatric-specific trends and take steps to improve.
The pediatric survival rate is higher in the hospital setting, but pediatric codes still present unique challenges for resuscitation teams. Read our blog post to learn why — and what hospitals can do to optimize care.
Virani, S.S., Alonso A., Benjamin E.J., et. al. Heart disease and stroke statistics—2020 update: a report from the American Heart Association. Circulation. 2020 Mar;141:e139-e596.
Holmberg, M. J., Wiberg, S., Ross, C. E., et. al. (2019). Trends in survival after pediatric in-hospital cardiac arrest in the United States. Circulation, 140(17), 1398–1408. https://doi.org/10.1161/circulationaha.119.041667
Fink, E. L., Prince, D. K., Kaltman, J. R., et. al. (2016). Unchanged pediatric out-of-hospital cardiac arrest incidence and survival rates with regional variation in North America. Resuscitation, 107, 121–128. https://doi.org/10.1016/j.resuscitation.2016.07.244
Berger, S. (2017). Survival from out‐of‐hospital cardiac arrest: Are we beginning to see progress? Journal of the American Heart Association, 6(9). https://doi.org/10.1161/jaha.117.007469
Shekhar, A. C., Campbell, T., Mann, N., et. al. (2022). Age and racial/ethnic disparities in pediatric out-of-hospital cardiac arrest. Circulation, 145(16), 1288–1289. https://doi.org/10.1161/circulationaha.121.057508
CARES: Cardiac Arrest Registry to Enhance Survival. Available at: About CARES « MyCares