Out-of-hospital cardiac arrest incidence and temporal trends in Ecuador: a national cross-sectional study

Out-of-hospital cardiac arrest (OHCA) is a leading global cause of mortality, with wide regional disparities in incidence. While high-income countries have national OHCA registries national data from Latin America remain scarce, limiting context-specific emergency planning.

To describe the incidence and temporal trends of confirmed EMS-attended OHCA in Ecuador from 2022 to 2024, and to explore ecological correlations with cardiovascular and socioeconomic indicators.

We conducted a retrospective observational study, following STROBE guidelines, using confirmed OHCA cases recorded by the Integrated Security Service (SIS ECU 9-1-1) from 1 January 2022 to 31 December 2024. Temporal and geographic trends were analysed and visualised. Incidence rates were calculated per 100,000 inhabitants, and province-year ecological associations with hypertension, diabetes, acute myocardial infarction and gross value added (GVA) were assessed using Spearman's rank correlation.

SIS ECU 9-1-1 recorded 936,784 emergency events, of which 9942 (1.06%) were confirmed EMS-attended OHCA cases. National incidence decreased from 20.51 per 100,000 inhabitants in 2022 to 18.71 in 2023 and 16.52 in 2024. Higher adjusted rates were observed in Loja, Imbabura and Carchi, while Guayas showed persistently low rates. OHCA correlated moderately with diabetes (rho = 0.463; p < 0.001) and weakly but significantly with acute myocardial infarction (rho = 0.382; p < 0.001). Associations with hypertension and GVA were weak and non-significant.

This first national epidemiological profile of OHCA in Ecuador shows declining incidence, geographical heterogeneity and relevant ecological associations with diabetes and acute myocardial infarction. The findings support a national OHCA registry and targeted prevention and emergency-response strategies.