{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T10:02:05Z","timestamp":1776333725968,"version":"3.51.2"},"reference-count":15,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Background: Pediatric out-of-hospital cardiac arrest (OHCA) is rare and associated with poor outcomes. Evidence from physician-staffed EMS systems remains limited. This study aimed to describe the incidence, presenting rhythms, EMS response intervals, and outcomes of pediatric OHCA, and to describe incidence, presenting rhythms, EMS response intervals, and prehospital outcomes in a local physician-staffed EMS system. Methods: We conducted a retrospective study of all pediatric (0\u201317 years) OHCA cases managed by the ASL Lecce physician-staffed EMS (southern Italy) between 2013 and 2025. Data were abstracted from standardized records. Variables included demographics, initial rhythm, EMS response intervals, temporal patterns, and return of spontaneous circulation (ROSC). The primary outcome was ROSC during prehospital care. Results: Twenty-seven cases were identified, corresponding to a cumulative incidence of 22.9 per 100,000 children over the study period (annualized incidence 1.73 per 100,000 children-year). Mean age was 11.9 \u00b1 5.5 years (median 15); 59% were male. Initial rhythms were asystole in 81% and ventricular fibrillation (VF) in 19%; no pulseless ventricular tachycardia (pVT) or pulseless electrical activity (PEA) were recorded. Five patients had shockable rhythms, with seven shocks delivered overall. Mean time intervals were: event-to-call 1.0 \u00b1 0.6 min, call-to-arrival 10.3 \u00b1 4.1 min, event-to-arrival 11.3 \u00b1 4.4 min. Arrests clustered during daytime (63%) and summer (41%). ROSC occurred in three patients (11%), two with VF and one with asystole; all arrests with ROSC were daytime events. In descriptive comparisons, ROSC cases showed a shorter call-to-arrival interval (T1\u2013T2), whereas no consistent pattern was observed across all prehospital time intervals. Conclusions: Pediatric OHCA in this Italian physician-staffed EMS was infrequent, usually presented with asystole, and rarely achieved ROSC. Shockable rhythms were associated with better outcomes. Given the small sample size, findings related to response times should be interpreted with caution. System preparedness should include pediatric-specific training, early defibrillation access, and multicenter registries to improve care and track outcomes.<\/jats:p>","DOI":"10.3390\/jcdd13040170","type":"journal-article","created":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T09:04:42Z","timestamp":1776330282000},"page":"170","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pediatric Out-of-Hospital Cardiac Arrest in a Physician-Staffed EMS System: A 13-Year Retrospective Descriptive Study from Southern Italy"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2367-4468","authenticated-orcid":false,"given":"Luca Gregorio","family":"Giaccari","sequence":"first","affiliation":[{"name":"Service of Anesthesia and Intensive Care, Vito Fazzi Hospital, 73100 Lecce, Italy"},{"name":"Department of Woman, Child, General and Specialized Surgery, University of Campania \u201cLuigi Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8984-9046","authenticated-orcid":false,"given":"Gaetano","family":"Tammaro","sequence":"additional","affiliation":[{"name":"Service of Anesthesia and Intensive Care, Vito Fazzi Hospital, 73100 Lecce, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicola","family":"D\u2019Angelo","sequence":"additional","affiliation":[{"name":"Emergency Medical Service 118, Local Health Authority (ASL) Lecce, 73100 Lecce, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniele","family":"Antonaci","sequence":"additional","affiliation":[{"name":"Presidio Ospedaliero Veris Delli Ponti, Scorrano, ASL Lecce, 73020 Scorrano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eva","family":"Epifani","sequence":"additional","affiliation":[{"name":"Service of Anesthesia and Intensive Care, Vito Fazzi Hospital, 73100 Lecce, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luciana","family":"Mascia","sequence":"additional","affiliation":[{"name":"Department of Experimental Medicine, University of Salento, 73100 Lecce, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Caterina","family":"Pace","sequence":"additional","affiliation":[{"name":"Department of Woman, Child, General and Specialized Surgery, University of Campania \u201cLuigi Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9999-3388","authenticated-orcid":false,"given":"Vincenzo","family":"Pota","sequence":"additional","affiliation":[{"name":"Department of Woman, Child, General and Specialized Surgery, University of Campania \u201cLuigi Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0873-3586","authenticated-orcid":false,"given":"Pasquale","family":"Sansone","sequence":"additional","affiliation":[{"name":"Department of Woman, Child, General and Specialized Surgery, University of Campania \u201cLuigi Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"100902","DOI":"10.1016\/j.resplu.2025.100902","article-title":"Pediatric cardiac arrest registries and survival outcomes: A European study","volume":"22","author":"Markel","year":"2025","journal-title":"Resusc. Plus"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.resuscitation.2016.01.018","article-title":"Extracorporeal resuscitation for refractory out-of-hospital cardiac arrest in adults: A systematic review of international practices and outcomes","volume":"101","author":"Hornby","year":"2016","journal-title":"Resuscitation"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1484","DOI":"10.1161\/CIRCULATIONAHA.108.802678","article-title":"Epidemiology and outcomes from out-of-hospital cardiac arrest in children: The Resuscitation Outcomes Consortium Epistry\u2013Cardiac Arrest","volume":"119","author":"Atkins","year":"2009","journal-title":"Circulation"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1016\/j.annemergmed.2005.05.028","article-title":"Out-of-hospital pediatric cardiac arrest: An epidemiologic review and assessment of current knowledge","volume":"46","author":"Donoghue","year":"2005","journal-title":"Ann. Emerg. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e812","DOI":"10.1542\/peds.2010-3886","article-title":"Age-specific differences in outcomes after out-of-hospital cardiac arrests","volume":"128","author":"Nitta","year":"2011","journal-title":"Pediatrics"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e002122","DOI":"10.1161\/JAHA.115.002122","article-title":"Survival after out-of-hospital cardiac arrest in children","volume":"4","author":"Jayaram","year":"2015","journal-title":"J. Am. Heart Assoc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/0300-9572(95)00888-Z","article-title":"Paediatric out-of-hospital cardiac arrests\u2014Epidemiology and outcome","volume":"30","author":"Kuisma","year":"1995","journal-title":"Resuscitation"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1016\/j.resuscitation.2021.02.015","article-title":"European Resuscitation Council Guidelines 2021: Paediatric Life Support","volume":"161","author":"Turner","year":"2021","journal-title":"Resuscitation"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1016\/j.resuscitation.2019.12.042","article-title":"Survival after out-of-hospital cardiac arrest in Europe: Results of the EuReCa TWO study","volume":"148","author":"Wnent","year":"2020","journal-title":"Resuscitation"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.resuscitation.2016.10.030","article-title":"Epidemiology and outcomes from out-of-hospital cardiac arrests in England","volume":"110","author":"Hawkes","year":"2017","journal-title":"Resuscitation"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1001\/jama.295.1.50","article-title":"First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults","volume":"295","author":"Nadkarni","year":"2006","journal-title":"JAMA"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e247909","DOI":"10.1001\/jamanetworkopen.2024.7909","article-title":"Survival After Out-of-Hospital Cardiac Arrest Before and After Legislation for Bystander CPR","volume":"7","author":"Li","year":"2024","journal-title":"JAMA Netw. Open"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1161\/CIRCULATIONAHA.112.125625","article-title":"Duration of cardiopulmonary resuscitation and illness category impact survival and neurologic outcomes for in-hospital pediatric cardiac arrest","volume":"127","author":"Matos","year":"2013","journal-title":"Circulation"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1001\/jamapediatrics.2014.2616","article-title":"Improving cardiopulmonary resuscitation with a CPR feedback device and refresher simulations (CPR CARES Study): A randomized clinical trial","volume":"169","author":"Cheng","year":"2015","journal-title":"JAMA Pediatr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1542\/peds.2008-1930","article-title":"A quantitative analysis of CPR quality during in-hospital resuscitation of older children and adolescents","volume":"124","author":"Sutton","year":"2009","journal-title":"Pediatrics"}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/13\/4\/170\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T09:24:47Z","timestamp":1776331487000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/13\/4\/170"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,16]]},"references-count":15,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["jcdd13040170"],"URL":"https:\/\/doi.org\/10.3390\/jcdd13040170","relation":{},"ISSN":["2308-3425"],"issn-type":[{"value":"2308-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,16]]}}}