Pediatric out-of-hospital cardiac arrest (POHCA) is uncommon and carries substantial risks of death and long-term neurological impairment. Following Pediatric Advanced Life Support recommendations helps unify in-hospital management and may enhance survival. We proposed that in-hospital treatment of POHCA varied and that departures from guideline-based practice were linked to increased mortality. Children experiencing POHCA in the London-Middlesex area from January 2012 to June 2020 were analyzed. Care during active resuscitation (intra-arrest) and outcomes after resuscitation were assessed using the Children’s Hospital, London Health Sciences Centre (LHSC) database and the Adverse Event Management System. A total of 50 POHCA cases reached hospital care; 15 (30%) were admitted, and 2 (4.0%) were discharged alive, both exhibiting severe neurological deficits without improvement at 90 days. Deviations were noted in every case, with most intra-arrest departures involving drug administration and defibrillation (98%). Post-arrest issues occurred primarily with temperature surveillance (60%). Missing data accounted for 15.9% of intra-arrest variables and 1.7% of post-arrest elements. Guideline deviations were frequent in both active resuscitation and subsequent care. The sample was insufficient to determine links between deviations and clinical outcomes. Future efforts should target the improvement of specific intra-arrest and post-arrest practices in POHCA and enhance digital documentation processes.
