Pediatric in-hospital life-threatening emergencies and cardiac arrest in France: adherence to international guidelines and barriers to implementation

Background: Pediatric in-hospital cardiac arrest (pIHCA) and pediatric in-hospital life-threatening emergencies (pIHLTE) are rare but require rapid, coordinated, guideline-based responses. Little is known about hospitals organization and adherence to international recommendations for these situations. This study evaluated practices regarding the prevention, management, and follow-up of pIHLTE and pIHCA. Methods: A nationwide cross-sectional survey was sent to all French hospitals providing pediatric care (November 2023-December 2024). Questionnaire assessed adherence to 15 recommendations from European Resuscitation Council guidelines, covering prevention, treatment, and post-event processes. Analyses were conducted at hospital level. Results: Among 263 eligible hospitals, 181 (68.8%) responded. Adherence to individual recommendations ranged from 25% to 100%. All hospitals reported an emergency call system, an pediatric advanced life support (PALS) response, and personnel trained in advanced pediatric cardiopulmonary resuscitation (CPR). Hospitals followed a median of 10/15 recommendations (IQR 7-12), and 36% met more than 11. Dedicated PALS teams existed in 35% centers; response times