Abstract Body: Introduction: Pediatric out-of-hospital cardiac arrest (pOCHA) is fatal in >90% of cases. We previously found that OHCA incidence in non-Hispanic Black (Black) children was triple that of non-Hispanic White (White) children, particularly in infancy (<1y). Infant OHCA is unlikely to be witnessed and results in the lowest survival. Witnessed status and bystander cardiopulmonary resuscitation (bCPR) are often analyzed independently, despite potentially differences in bCPR effectiveness by witnessed status. We aimed to evaluate differences in witnessed status, bCPR and outcome by age/race in pOHCA.

Hypothesis: We hypothesized that 1) Black pOHCA was less likely to be witnessed as driven by higher frequency of infantile OHCA, and 2) unwitnessed pOHCA would be associated with lower survival despite bCPR.

Methods: We included all 911 calls for non-traumatic pOHCA in Houston, 2006-2024. We performed univariable and multivariable logistic regression for survival to hospital discharge. We then compared frequency of bCPR, witnessed status, and bCPR with witnessed status (3 variables) stratified by by age and race/ethnicity using chi-square and Fisher’s exact test.

Results: Of 971 pOHCA, cases were predominantly Black (50.4%), followed by Hispanic (36.9%), White (10.1%), and other (2.6%). Survival to discharge was 6.9%. Black and Hispanic children less frequently survived to discharge (5.2% and 7.2% respectively) compared to non-White children (15.0%, p=0.003). Race/ethnicity was no longer significantly associated with survival after controlling for presenting rhythm and witnessed status. pOHCA cases receiving bCPR resulted in 8.8% survival to discharge when witnessed compared to 5.4% when unwitnessed (p=0.048). Sixty-three percent of OHCA in Black children was in infancy compared to White children (56.1%, p=0.02) and Black infants were less frequently witnessed compared to White infants (16.8% vs. 21.8%, p=0.01). Among White teens (ages 15-17y), 61.5% of OHCA was both witnessed and with bCPR compared to 29.0% and 22.0% in Black and Hispanic teens, respectively with higher proportions of bCPR among White teens (Table).

Conclusions: OHCA in Black children are more likely to be infantile, less likely to be witnessed, and less likely when witnessed to receive bCPR, while Hispanic children are less likely to receive bCPR compared to White children. Findings will help target future interventions aimed at reducing disparities in outcomes.