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To describe the epidemiology and outcomes of out-of-hospital cardiac arrest (OHCA) in a Hong Kong (HK) pediatric population and to identify factors associated with favorable outcomes.Retrospective case note review of patients younger than 18 years who presented to the emergency department of Prince of Wales Hospital, HK with cardiac arrest from 2003 to 2013. Patients were classified as infants (<1 year), children (1–11 years) and adolescents (12–18 years). Patient characteristics, OHCA details, interventions, and outcomes were reported following the Utstein format.There were 53 patients in the study (77.4% men) and 34.6% of patients had chronic illnesses. In the infant group, 35.7% had complicated pregnancies. The incidence of OHCA in HK was 5.37 per 100,000 person-years. Out-of-hospital cardiac arrest was identified by bystanders in 62.3%, but bystander cardiopulmonary resuscitation was provided in only 28.3%. Shockable rhythms were uncommon (9.4%). Most OHCA in infants had unknown causes. In children, commonest causes were respiratory illness and environmental hazards, and in adolescents, trauma and cardiogenic events. Overall survival to hospital discharge rate was 20.8%; 13.2% had good neurological outcomes. Bystander cardiopulmonary resuscitation (odds ratio [OR], 7.44; 95% confidence interval [95% CI], 1.75–31.7; P = 0.007), prehospital return of spontaneous circulation (OR, 11.4; 95% CI, 1.75–74.7; P = 0.013), and return of spontaneous circulation within 30 minutes (OR, 90.0; 95% CI, 11.1–727; P < 0.0005) were associated with survival to discharge.The incidence of OHCA in HK is comparable to global data. The outcome of OHCA in the pediatric population has improved over the decades. Better prehospital care could improve outcome.