# The impact of public access defibrillation on outcomes for children experiencing out-of-hospital cardiac arrest: a 25-year retrospective study

## TL;DR

This study finds that public access defibrillation improved outcomes for children with out-of-hospital cardiac arrests over 25 years.

## Contribution

The study provides the first long-term analysis of PAD impact on pediatric OHCA outcomes using a 25-year dataset.

## Key findings

- PAD use increased significantly over time, from 0% in 2000–04 to 35.7% in 2020–24.
- PAD was associated with improved odds of ROSC, event survival, and survival to hospital discharge before adjusting for confounders.
- Survival to hospital discharge improved significantly over time, with higher odds in 2020–24 compared to 2000–04.

## Abstract

To evaluate the impact of public access defibrillation (PAD) on outcomes for children experiencing out-of-hospital cardiac arrest (OHCA).

This retrospective cohort study analysed paediatric (age <18 years), non-traumatic OHCA cases with an initial shockable rhythm from the Victorian Ambulance Cardiac Arrest Registry between 1 January 2000 and 31 December 2024. Cases witnessed to arrest by emergency medical services (EMS) were excluded. Cases were categorised based on the initial shock provider, either PAD or EMS. The association between PAD and patient outcomes was assessed in multivariable logistic regression models.

The study identified 140 shockable OHCA cases meeting the eligibility criteria, of which 23 (16.4%) received their first defibrillation via PAD. PAD use increased over the study period, from 0% in 2000–04 to 35.7% in 2020–24 across all locations and from 0% to 66.7% in public locations (p trend <0.001 for both). PAD use was significantly associated with improved unadjusted odds of ROSC (OR: 6.33; 95% CI: 1.42–28.30; p = 0.016), event survival (OR: 3.80; 95% CI: 1.22–11.86; p = 0.022), and survival to hospital discharge (OR: 5.11; 95% CI: 1.63–15.99; p = 0.005). However, these associations were not statistically significant after adjusting for confounders including the temporal trend. Survival to hospital discharge improved significantly over time (OR: 10.44; 95% CI: 2.26–48.15 for 2020–24 vs. 2000–04).

PAD in children increased significantly in our region over 25 years and was associated with a marked reduction in the time to first defibrillation.