Out-of-hospital cardiac arrest incidence and temporal trends in Ecuador: a national cross-sectional study

IntroductionOut-of-hospital cardiac arrest (OHCA) is a leading global cause of mortality, with wide regional disparities in incidence. While high-income countries have national OHCA registries, data remain scarce in Latin America, limiting the development of context-specific emergency response strategies. This study aimed to determine the national incidence and spatiotemporal distribution of OHCA in Ecuador between 2022 and 2024. MethodsA retrospective observational study was conducted following STROBE guidelines. All OHCA cases reported through the Integrated Security Service (SIS ECU 9-1-1) from January 1, 2022, to December 31, 2024, were included. Temporal and geographic trends were analyzed using frequency distributions, population-adjusted incidence rates, and spatial visualization tools. Statistical analysis was performed using R; spatial data were mapped using SCImago Graphica. ResultsA total of 9,942 OHCA cases were recorded among 936,784 emergency events (1.06%). Annual case counts decreased from 3,635 in 2022 to 2,969 in 2024, with incidence rates falling from 20.51 to 16.52 per 100,000 inhabitants. OHCA cases exhibited seasonal peaks in January and December. Provinces such as Loja, Imbabura, and Carchi showed the highest incidence rates, while Pichincha recorded the greatest absolute number of cases. Although most provinces showed declining trends, others--such as Los Rios-- experienced increases. Geographic disparities suggest potential influences from demographic, environmental, or systemic healthcare factors. ConclusionsThis study provides the first national epidemiological profile of OHCA in Ecuador, revealing clear temporal and geographic variability. The findings serve as a critical step toward building an evidence base for OHCA in Ecuador and Latin America, highlighting the need for further research and the establishment of a national OHCA registry to inform policy and policy development. What is Known; What the Study AddsO_ST_ABSWhat is KnownC_ST_ABSO_LIOut-of-hospital cardiac arrest (OHCA) is a leading cause of mortality worldwide, with significant variation in incidence across countries. C_LIO_LIMost epidemiological data on OHCA originate from high-income countries with established national registries. C_LIO_LILatin America lacks comprehensive national-level data on OHCA, limiting regional understanding and evidence-based health policy design. C_LI What the Study AddsO_LIThis study provides the first national epidemiological analysis of OHCA incidence and spatiotemporal trends in Ecuador, addressing a major regional data gap. C_LIO_LIThe findings establish a foundational dataset for Latin America that can inform future research, guide EMS system strengthening, and support the development of context-specific OHCA prevention and response strategies. C_LI