Higher rates of infant cardiac arrest linked to socioeconomic disadvantage, new research finds

Infants under the age of one living in disadvantaged areas across metropolitan Perth are at the highest risk of experiencing paediatric out-of-hospital cardiac arrest (pOHCA), new research has shown.

Sadly, less than 8 per cent of 411 children survived pOHCA in Western Australia between 2015 and 2024, according to St John WA data analysed by Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU) at Curtin University.

In the first study of its kind, published paper ‘The impact of socioeconomic status on paediatric out-of-hospital cardiac arrest incidence and outcomes in Western Australia: a population-based cohort study’, PRECRU research author Dr Sarah Harris found nearly half of the 411 pOHCA incidents (n = 201; 48.9%) occurred in children living in low socioeconomic status (SES) areas, with incidence decreasing across higher socioeconomic advantage.

The majority of paediatric cardiac arrests across all socio-economic areas were from presumed cardiac, and medical reasons like anaphylaxis, medical-related respiratory, and sudden unexplained death of an infant [SUDI].

Leaving about a third due to external causes like drownings, electrocution, asphyxia, trauma or drug overdose, where “drowning accounted for a higher proportion of all OHCA events among low-SES children compared with mid- and high-SES children.”

Of the pOHCAs in low SES areas as outlined by the Australian Bureau of Statistics’ 2021 census, 72 per cent occurred in Perth metropolitan areas ringing around the eastern corridor to Butler and Clarkson in the north and Mundijong and Port Kennedy in the south.

Infants made up almost 43 per cent of pOHCAs in low SES areas across the state (n = 86; 42.79%) and the overall incidence rate was greater (54.3 per 100,000 children per year) than in young children aged 1 to 5 years (8.3 per 100,000 children per year) or children under 15 (4.8 per 100,000 children per year).

“Socioeconomic disadvantage was strongly associated with higher pOHCA incidence, with an overall near threefold difference between children living in the most and least disadvantaged areas,” Dr Harris wrote.

“The socioeconomic gradient was most pronounced in infancy, suggesting that early life may represent a period of heightened vulnerability to social determinants of health.

“These findings emphasise the importance of addressing socioeconomic disadvantage in paediatric prevention strategies and highlight the need for further large-scale studies to clarify mechanisms underpinning SES disparities in pOHCA incidence and outcomes.”

St John WA publishes an annual Out-of-Hospital Cardiac Arrest (OHCA) Report, with the latest results (2025) showing 41 paediatric OHCAs occurred and 12 of those were directly linked to sudden cardiac arrest, while a percentage related to SUDI, trauma, drowning and/or other means.

“Socioeconomic disadvantage may influence risk through adverse antenatal exposures, differences in access to and engagement with health services, suboptimal living environments, and variation in parental education and health literacy,” Dr Harris wrote in her report.

St John is working closely with the Heart Foundation and partners to deliver more health literacy, first aid accredited Community First Responders via the St John First Responder app and community accessible Automated External Defibrillators (AEDs) registered on the State Defibrillator Network for areas most in need.

As of October 16 (Restart a Heart Day), St John WA has mapped out-of-hospital cardiac arrest (OHCA) cases across Western Australia which occurred since 2021. The analysis shows that annualised OHCA rates per capita in the most socioeconomically disadvantaged 20 per cent of areas are more than double those in the least disadvantaged 20 per cent.

The report also maps automated external defibrillators (AEDs) registered on the State Defibrillator Network alongside OHCA locations, helping to identify potential gaps in AED coverage and highlighting the importance of expanding access to publicly available 24/7 defibrillators across the community.

St John WA’s commitment to provide greater aid to those experiencing an OHCA in a private residence will expand to all registered first aid accredited Community First Responders on St John’s First Responder app.

They will be eligible to receive incident notifications to cardiac arrests within private homes that are deemed safe to attend by the State Control Centre, which is in line with other States’ responses.

“Nearly 85 percent of OHCA in children, and 70 per cent all cases, occur in the home. Allowing first aid-accredited Community First Responders who are 500 metres from an incident, as well as alerting a nearby registered business with an AED to come and assist the Triple Zero (000) caller will help save lives,” St John WA Paramedic and Resuscitation Improvement Specialist Jason Belcher said.

“The heart of St John has always been empowering the community to respond to people in need. This expansion of our community first responder program means people can provide help to their neighbours in those vital first few minutes.”

Other key findings in 2025 OHCA Report:

• 151 (148 adults and 3 children) survived out of 1306 incidents (11.6%),
• Almost 94 per cent were recognised on a Triple Zero (000) call,
• CPR rates again soared to more than 82 per cent, with bystanders using an AED on 190 OHCA patients – a record of 16.5 per cent,
• AED shocks were delivered in 83 cases resulting in 48 (57.8%) having a pulse on arrival at ED and 38 (45.8%) surviving to 30 days,
• Almost 70 per cent of those 83 community AED shocked cases were due to a State Defibrillator Network activation,
• Response times improved on the previous year, with 9.3 minutes the median response time in Perth metro (down from 9.5 minutes) and 12.5 minutes (down from 13.6 minutes) in rural areas.

The WA OHCA database is maintained by PRECRU at Curtin University. Data was extracted from St John WA records and information for all Emergency Medical Services (EMS)-attended OHCAs.

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