Cardiac warning symptoms in paediatric out-of-hospital ventricular fibrillation cardiac arrest survivors

BACKGROUND: Out-of-hospital cardiac arrest (OHCA) in children is a rare but devastating event, with an estimated incidence of 9 per 100 000 person-years and a survival rate of less than 10%. OHCA may be the presenting event in children with undiagnosed cardiovascular disease. A substantial proportion of adults experiencing an unexpected OHCA report previous symptoms, but whether the same is true in paediatric survivors has not been systematically evaluated previously. This study aims to describe cardiac symptoms in children prior to presenting with OHCA. METHODS: Clinical characteristics and preceding symptoms of 58 consecutive patients aged 0-18 without a pre-existing causative diagnosis presenting with a survived OHCA between 1996 and 2025 to a single UK paediatric tertiary referral centre were reviewed. RESULTS: The median age at cardiac arrest was 11 years (IQR 7-14 years). 29 OHCA (50%) occurred on exertion. Following the OHCA, 42 patients (72.4%) were diagnosed with an inherited cardiac condition, most commonly hypertrophic cardiomyopathy (n=17, 29.8%). 18 patients (31.0%) had a family history of sudden cardiac death.28 patients (50.9%) had reported cardiac symptoms prior to their OHCA, including 13 (23.6%) who had experienced syncope. Of the 13 patients who experienced syncope, only three sought medical attention and none had follow-up arranged. CONCLUSIONS: Almost half of paediatric OHCA survivors had warning symptoms prior to their event, representing potential missed opportunities to identify an underlying diagnosis prior to OHCA. These findings highlight the need for more education, both for medical professionals and the general public, about 'red flag' symptoms.