Pediatric In-Hospital Cardiac Arrest in Sweden: A Tertiary Care Cohort With High Survival

Pediatric in-hospital cardiac arrest is a rare event. Despite Sweden's extensive national health registries, data describing pediatric in-hospital cardiac arrest are limited. In 2018, pediatric-specific variables were introduced into the Swedish Registry for Cardiopulmonary Resuscitation. This study aimed to identify the characteristics and outcomes of pediatric IHCA at a Swedish tertiary pediatric referral hospital following implementation of these variables.

This observational cohort study included all pediatric in-hospital cardiac arrest events with initiated cardiopulmonary resuscitation (CPR) recorded at Queen Silvia Children's Hospital between 2018 and 2025. Demographic characteristics, arrest location, resuscitation variables, and survival outcomes were analyzed. Survival was assessed using Kaplan-Meier methods and Cox proportional hazard regression.

A total of 125 in-hospital cardiac arrest events were included. Infants (< 1 year) represented 65.6% of cases and 57% of patients had congenital heart disease. Most arrests occurred in the intensive care unit (56.8%), followed by hospital wards (21.6%) and the operating room (16.0%). CPR was initiated within the first minute in 81.3% of cases. Return of spontaneous circulation was achieved in 90% of patients. Survival was 82% at 30 days and 68% at 1 year.

Pediatric in-hospital cardiac arrest occurring in highly monitored tertiary care environments has a very high rate of return of spontaneous circulation as well as survival. This study also highlights the importance of systematic registry data collection to improve understanding of pediatric in-hospital cardiac arrest and to support future benchmarking and quality improvement.

In-hospital cardiac arrest is rare for pediatric patients. This retrospective cohort analysis, from one tertiary care pediatric hospital which includes a large pediatric cardiac surgery activity, presents pediatric cardiac arrest events in the hospital, along with case factors.