# Pediatric in-hospital life-threatening emergencies and cardiac arrest in France: adherence to international guidelines and barriers to implementation

## TL;DR

This study finds that French hospitals have limited adherence to international guidelines for pediatric in-hospital emergencies and cardiac arrest, with issues in training, staffing, and standardized protocols.

## Contribution

The study provides the first nationwide assessment of guideline adherence for pediatric in-hospital emergencies in France, identifying specific barriers and gaps in implementation.

## Key findings

- Median adherence to 15 international pediatric emergency recommendations was 55% across 181 French hospitals.
- Only 35% of hospitals had dedicated pediatric ALS teams, and fewer than half ensured guideline-level BLS/ALS training.
- Barriers to guideline adherence included staffing shortages and lack of protected time for training and debriefing.

## Abstract

•Pediatric in-hospital cardiac arrest is rare, and European epidemiological data remain limited despite ERC/AHA guidelines.•In 181 French hospitals, median adherence to 15 international pediatric emergency recommendations was 55%.•Gaps involve prevention systems, standardized protocols, pediatric ALS teams, training and debriefing.•Only 35% had dedicated pediatric ALS team, and fewer than a half ensured guideline-level BLS/ALS training.•Staffing shortages and lack of protected time hinder implementation; stronger preparedness and harmonized training are needed.

Pediatric in-hospital cardiac arrest is rare, and European epidemiological data remain limited despite ERC/AHA guidelines.

In 181 French hospitals, median adherence to 15 international pediatric emergency recommendations was 55%.

Gaps involve prevention systems, standardized protocols, pediatric ALS teams, training and debriefing.

Only 35% had dedicated pediatric ALS team, and fewer than a half ensured guideline-level BLS/ALS training.

Staffing shortages and lack of protected time hinder implementation; stronger preparedness and harmonized training are needed.

Pediatric in-hospital cardiac arrest (pIHCA) and pediatric in-hospital life-threatening emergencies (pIHLTE) are rare but require rapid, coordinated, guideline-based responses. Little is known about hospitals organization and adherence to international recommendations for these situations. This study evaluated practices regarding the prevention, management, and follow-up of pIHLTE and pIHCA.

A nationwide cross-sectional survey was sent to all French hospitals providing pediatric care (November 2023–December 2024). Questionnaire assessed adherence to 15 recommendations from European Resuscitation Council guidelines, covering prevention, treatment, and post-event processes. Analyses were conducted at hospital level.

Among 263 eligible hospitals, 181 (68.8%) responded. Adherence to individual recommendations ranged from 25% to 100%. All hospitals reported an emergency call system, an pediatric advanced life support (PALS) response, and personnel trained in advanced pediatric cardiopulmonary resuscitation (CPR). Hospitals followed a median of 10/15 recommendations (IQR 7–12), and 36% met more than 11. Dedicated PALS teams existed in 35% centers; response times <3 min concerned 41%. Training remained inconsistent, with only 48% offering comprehensive Pediatric Basic Life Support (PBLS)/PALS programs. Debriefing practices varied: 60% conducted them routinely, 25% performed none. Barriers included time constraints (65%), medical (52%) or paramedical (48%) staffing shortages.

This nationwide study identifies key gaps in alignment with European guidelines for pIHCA and pIHLTE in France. Standardized emergency call numbers, minimum PALS certification coverage, and mandated debriefing and audit processes might improve care quality and consistency.