Rank | Nation | Swimmer | Time |
| Germany | Lea Boy Sarah Köhler Sören Meißner Rob Muffels | 53:58.7 |
| Italy | Rachele Bruni Giulia Gabbrielleschi Domenico Acerenza Gregorio Paltrinieri | 53:58.9 |
| United States | Haley Anderson Jordan Wilimovsky Ashley Twichell Michael Brinegar | 53:59.0 |
4 | Brazil | Ana Marcela Cunha Viviane Jungblut Diogo Villarinho Fernando Ponte | 54:24.5 |
5 | Australia | Chelsea Gubecka Hayden Cotter Kareena Lee Nicholas Sloman | 54:36.8 |
6 | France | Lara Grangeon David Aubry Aurélie Muller Marc-Antoine Olivier | 54:37.1 |
7 | Netherlands | Esmee Vermeulen Sharon van Rouwendaal Pepijn Smits Ferry Weertman | 54:37.2 |
8 | Hungary | Réka Rohács Gergely Gyurta Anna Olasz Kristóf Rasovszky | 55:02.7 |
9 | China | Hou Yawen Cheng Long An Jiabao Xin Xin | 55:14.8 |
10 | Russia | Anastasia Basalduk Denis Adeev Valeriia Ermakova Kirill Abrosimov | 55:19.1 |
11 | Great Britain | Danielle Huskisson Alice Dearing Tobias Robinson Jack Burnell | 55:31.1 |
12 | Spain | Paula Ruiz Guillem Pujol María de Valdés Álvarez Raúl Santiago Betancor | 55:31.5 |
13 | Canada | Kate Sanderson Hau-Li Fan Chantel Jeffrey Eric Hedlin | 56:20.3 |
14 | Japan | Yumi Kida Takeshi Toyoda Minami Niikura Taiki Nonaka | 56:52.1 |
15 | South Africa | Michelle Weber Danie Marais Robyn Kinghorn Chad Ho | 56:52.9 |
16 | Israel | Yonatan Rosin Matan Roditi Eva Fabian Eden Girloanta | 57:24.5 |
17 | Mexico | Martha Aguilar Daniel Delgadillo Martha Sandoval Arturo Pérez Vertti | 58:37.0 |
18 | South Korea | Ban Seon-jae Park Seok-hyun Jung Ha-eun Jae Park | 58:59.0 |
19 | Venezuela | Liliana Hernández Wilder Carreno Paola Pérez Diego Vera | 59:01.0 |
20 | Ecuador | David Farinango Nataly Caldas Calle Ana Abad David Castro | 59:37.9 |
21 | Hong Kong | William Thorley Keith Sin Nip Tsz Yin Wong Cho Ying | 1:00:37.9 |