Paediatric traumatic out-of-hospital cardiac arrest: A systematic review and meta-analysis

Aim: In this study, we sought to quantitatively describe the survival outcomes, incidence rates, and predictors of survival after paediatric traumatic out-of-hospital cardiac arrest (OHCA). Methods: We systematically searched MEDLINE, EMBASE, EMCARE, and CINAHL to identify observational or interventional studies reporting relevant data for paediatric traumatic OHCA. The Joanna Briggs Institute critical appraisal tool for prognostic studies was used to assess study quality. We analysed the survival outcomes and pooled incidence rates per 100,000 person-years using random-effect models. Results: Nineteen articles met the eligibility criteria involving 705 Emergency Medical Service (EMS)-attended and 973 EMS-treated traumatic paediatric OHCAs across an estimated serviceable population of 15.2 million. Four studies were conducted in the Asia-pacific region, seven in Europe, and eight in North America. Nine studies were assessed as low quality. Overall pooled survival to hospital discharge or 30-day survival for the EMStreated cases was 1.2% (n = 6 studies; 95% confidence interval (CI): 0.1%, 3.1%; I-2 = 26.1%). The pooled rate of return of spontaneous circulation in four studies was 22.1% (95% CI: 18.4%, 26.1%; I-2 = 0.0%), and the pooled rate of event survival was 18.8% (n = 3 studies; 95% CI: 15.2%, 22.7%; I-2 = 0.0%). The pooled incidence of EMS-treated paediatric traumatic OHCA was 1.6 cases per 100,000 person-years (n = 10 studies; 95% CI: 1.1, 2.2; I-2 = 98.1%). No study reported on the impact of epidemiological or clinical factors on survival. Conclusion: Survival outcomes of paediatric traumatic OHCA are poor and existing studies report varying incidence rates. The absence of large prospective and international registry data hinders the development of novel strategies to improve survival rates.