This nationwide study used Japan's administrative inpatient database (2011–2022) to examine incidence, survival, resuscitation characteristics, and temporal trends of pediatric in-hospital cardiac arrest (IHCA) in patients under 18 years old, across 7,117,481 eligible admissions.
IHCA incidence was 0.98 per 1,000 admissions overall, declining from 1.03 (2011) to 0.86 (2022; P=0.009). Survival to discharge improved from 25.8% to 29.6% over the same period (overall 30.6%; P=0.006). Median age was 1 year, 55.8% male; median chest compression duration was 23 minutes. Adrenaline was used in 71.0% and tracheal intubation in 61.7% of cases.
- Case ascertainment was code-based (chest compression procedure code), not registry-validated, risking both over- and under-identification of true IHCA. - Administrative data lack granular resuscitation detail (e.g., rhythm, cause, neurological outcomes). - Most hospitals managed only 1–2 pediatric IHCA cases per year, limiting site-level quality assessment.
Pediatric IHCA in Japan is rare (~1 per 1,000 admissions) and most hospitals see only 1–2 cases annually, underscoring the need for centralized expertise and registry-based monitoring. Improving but still low survival (~30%) highlights ongoing gaps in resuscitation outcomes that a national registry could help address.
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