Pediatrics World Conference 2026

Abstract

Background:

Paediatric in-hospital cardiac arrest (IHCA) is a sentinel event that reflects both the quality of acute care and the strength of healthcare systems. While high-income countries have reported survival rates of up to 40–50%, evidence from the Middle East remains limited. Jordan, despite having tertiary teaching hospitals and accredited training centres, continues to lack a national framework for resuscitation practices. This study provides the first comprehensive analysis of paediatric IHCA in Jordan, exposing critical gaps in care delivery, training, and policy.

Methods:

A retrospective observational study was conducted at King Abdullah University Hospital (2015–2022). All children aged 1 month to 18 years who received cardiopulmonary resuscitation (CPR) were included. Cases were classified as pulseless rhythm or bradycardia with poor perfusion. Outcomes included incidence, return of spontaneous circulation (ROSC), and survival to hospital discharge. Multivariable logistic regression was applied to identify predictors of survival.
Results: Among 80,534 admissions, 504 children underwent CPR, yielding an incidence of 6.26/1,000—comparable to developed settings. Yet survival to discharge was strikingly low at 4.8%. Pulseless rhythms dominated (78.2%), with only one-quarter of patients achieving ROSC. Bradycardia cases showed higher ROSC but did not translate into meaningful survival gains. Notably, survival improved modestly year-on-year (24% annual increase). Children with neurological or cardiac comorbidities, those outside intensive care units, and those with respiratory causes had better odds of survival, whereas repeated epinephrine dosing predicted poorer outcomes.

Conclusion:

This study reveals a paradox: incidence rates in Jordan mirror those of wealthier nations, yet survival remains critically lower. Contributing factors include delayed recognition, limited post-resuscitation infrastructure, inconsistent training, and the absence of clear Do Not Resuscitate (DNR) policies, which lead to 'social CPR' with little clinical benefit. These findings highlight equity gaps in paediatric critical care and call for urgent investment in resuscitation systems, legal and ethical frameworks, and national registries. Improving paediatric IHCA outcomes in Jordan could serve as a model for advancing equity and access in low- and middle-income countries facing similar systemic challenges.