Pediatric Cardiac Arrest Outcomes by Child Opportunity Index Area and Race and Ethnicity

Monday, March 23, 2026

11:30 AM - 12:30 PM Central Time

Location: Connections Central - RST 17

Jessica A. Barreto, MD MS

Boston Children’s Hospital

Disclosure(s): No relevant financial relationship(s) to disclose.
NV

Nishma Valikodath, MD

Pediatric Cardiology Fellow
Boston Children's Hospital

Disclosure information not submitted.
JL

Jessica Liu, MPH MBA

Biostatistician
Biostatistics and Research Design (BARD) Center, Boston Children's Hospital

Disclosure information not submitted.
CR

Cailyn Rood, MD

Pediatric Cardiac Intensivist
Boston Children's Hospital

Disclosure information not submitted.
VW

Valerie Ward, MD, MPH

Chief Health Equity Officer
Boston Children's Hospital

Disclosure information not submitted.
RT

Ravi Thiagarajan, MD, MPH (he/him/his)

Boston Children’s Hospital, Massachusetts

Disclosure information not submitted.
EW

Edie Weller, PhD

Biostatistician
Biostatistics and Research Design (BARD) Center, Boston Children's Hospital

Disclosure information not submitted.
MN

Maryam Naim, MD, MSCE

Pediatric Cardiac Intensivist
Children's Hospital of Philadelphia

Disclosure information not submitted.
KM

Katie Moynihan, MBBS

Pediatric Cardiac Intensivist
Boston Children's Hospital

Disclosure information not submitted.

Introduction: Studies in adults and children have shown unacceptable disparities in out-of-hospital cardiac arrest (OHCA) risk, outcomes and bystander CPR (BCPR) provision. This study evaluated the association between the Child Opportunity Index (COI) and race and ethnicity and pediatric OHCA outcomes and the role of BCPR as a mediator. We hypothesized that arrests in lower COI neighborhoods are associated with worse outcomes, and that lower BCPR mediates this association.

Methods: This is a retrospective cohort study using the Cardiac Arrest Registry to Enhance Survival (CARES) of children ≤18 years with OHCA. The exposures were COI quintiles (very low indicates the most disadvantaged neighborhoods) and race and ethnicity. The primary outcome was survival to hospital discharge with favorable neurological outcome (Pediatric Cerebral Performance Category ≤2). Associations of exposures with outcome were determined using logistic regression and mediation analysis was used to evaluate the indirect effect of BCPR.

Results: Overall, 1654/17903 (9.24%) had a favorable outcome. Arrests in lower COI neighborhoods and in Black/African-American children occurred more frequently in infants and were less likely to be witnessed and to receive BCPR. Arrests in very low COI areas (vs very high COI, adjusted odds ratio aOR 0.68 [95% CI 0.54-0.84], P<.001) and Black/African American race (vs non-Hispanic White, aOR 0.81 [95% CI 0.69-0.96], P=.02) were independently associated with lower odds of a favorable outcome. Lower BCPR partially mediated worse outcomes associated with lower COI quintiles (adjusted percent mediated: 11.67% [95% CI 5.48-17.87], P<.001) and Black/African American race (15.57% [95% CI 7.54-23.61], P<.001).

Conclusions: Arrests occurring in lower COI areas and among Black/African American children were associated with lower odds of a favorable outcome. Lower bystander response partially explained these associations. This is the first pediatric study to apply mediation analysis to explore mechanisms behind OHCA disparities, informing future research and policy. These data suggest a need to focus on arrest prevention and understand barriers and facilitators to improve bystander response.