Patterns and Determinants of Pediatric Cardiac Arrest: Epidemiology, Mechanisms, and Clinical Implications

Abstract

Pediatric cardiac arrest differs fundamentally from adult cardiac arrest in its etiology, pathophysiology, and clinical course. Unlike adults, pediatric arrests are more often secondary to respiratory failure or circulatory shock, although congenital heart disease, cardiomyopathy, channelopathies, and other primary cardiac causes contribute to a clinically important subset. This narrative review synthesizes contemporary evidence identified through targeted literature searches of PubMed/MEDLINE, Scopus, and Google Scholar, focusing on epidemiology, mechanisms, rhythm patterns, resuscitation strategies, and registry systems in pediatric cardiac arrest. Pediatric cardiac arrest commonly follows a hypoxia-driven progression characterized by respiratory compromise, bradycardia, hypotension, and eventual asystole or pulseless electrical activity. Nonshockable rhythms predominate, while shockable rhythms are more frequent in selected adolescents and children with primary cardiac disease. Outcomes vary substantially by arrest setting, with in-hospital events generally demonstrating higher survival than out-of-hospital arrest. Improving outcomes requires early recognition, high-quality resuscitation, structured post-cardiac arrest care, and robust registry systems, particularly in resource-variable settings.