Characteristics and outcomes of out-of-hospital cardiac arrest among students under school supervision in Japan: a descriptive epidemiological study (2008-2021).

Kosuke KIYOHARA; Mamoru AYUSAWA; Masahiko NITTA; Takeichiro SUDO; Taku IWAMI; Ken NAKATA; Yuri KITAMURA; Tetsuhisa KITAMURA

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Characteristics and outcomes of out-of-hospital cardiac arrest among students under school supervision in Japan: a descriptive epidemiological study (2008-2021).

Author: Kosuke KIYOHARA ¹ ; Mamoru AYUSAWA ² ; Masahiko NITTA ³ ; Takeichiro SUDO ⁴ ; Taku IWAMI ⁵ ; Ken NAKATA ⁶ ; Yuri KITAMURA ⁷ ; Tetsuhisa KITAMURA ⁷
Author Information

1. Department of Food Science, Faculty of Home Economics, Otsuma Women's University.
2. Department of Nutrition and Health Science, Faculty of Health and Medical Science, Kanagawa Institute of Technology.
3. Department of Emergency Medicine, Osaka Medical and Pharmaceutical University.
4. Institute of Human Culture Studies, Otsuma Women's University.
5. Department of Preventive Services, Kyoto University School of Public Health.
6. Medicine for Sports and Performing Arts, Department of Health and Sports Sciences, Graduate School of Medicine, Osaka University.
7. Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University.
Publication Type:Journal Article
Keywords: Epidemiology; Etiology of arrest; Japan; Out-of-hospital cardiac arrest; School; Students
MeSH: Out-of-Hospital Cardiac Arrest/etiology*; Humans; Japan/epidemiology*; Male; Female; Child; Students/statistics & numerical data*; Schools/statistics & numerical data*; Adolescent; Cardiopulmonary Resuscitation/statistics & numerical data*; Emergency Medical Services/statistics & numerical data*; Epidemiologic Studies
From:Environmental Health and Preventive Medicine 2025;30():4-4
CountryJapan
Language:English
Abstract: BACKGROUND:A comprehensive understanding of the epidemiology of pediatric out-of-hospital cardiac arrest (OHCA) occurring under school supervision is lacking. We aimed to comprehensively describe the characteristics and outcomes of OHCA among students in elementary schools, junior high schools, high schools, and technical colleges in Japan.
METHODS:OHCA data from 2008-2021 were obtained from the SPIRITS study, which provides a nationwide database of OHCAs occurring under school supervision across Japan. We included cases in which resuscitation was attempted by emergency medical service personnel or bystanders. The cases were classified into three groups based on their etiology: cardiac, non-cardiac, and traumatic origin. The primary outcome was one-month survival with favorable neurological outcomes, defined as a Glasgow-Pittsburgh cerebral performance category of 1 or 2. The demographic characteristics, event details, and outcomes were compared across the three groups by using χ² tests for categorical variables and one-way analyses of variance for continuous variables.
RESULTS:During the 14-year study period, 602 OHCA cases were confirmed, with 430 (71.4%) classified as cardiac, 91 (15.1%) as non-cardiac, and 81 (13.5%) as traumatic origin. Non-cardiac and traumatic cases were less likely to be witnessed at the time of arrest (46.2% and 42.0%, respectively) than cardiac cases (82.6%; p < 0.001). Initiation of cardiopulmonary resuscitation by bystanders was less common in non-cardiac and traumatic cases (62.6% and 42.0%, respectively) than that in cardiac cases (82.8%; p < 0.001). The delivery of defibrillation using public-access automated external defibrillators was also significantly less frequent in non-cardiac (3.3%) and traumatic cases (6.2%) than that in cardiac cases (59.8%; p < 0.001). Ventricular fibrillation (VF) as the first documented rhythm was observed in 77.9% of cardiac cases but was much less common in non-cardiac (5.5%) and traumatic cases (8.6%; p < 0.001). One-month survival with favorable neurological outcomes was significantly lower in non-cardiac (6.6%) and traumatic cases (0%) than that in cardiac cases (50.2%; p < 0.001).
CONCLUSIONS:OHCAs of cardiac origin were more frequently associated with VF and had relatively good prognoses. In contrast, OHCAs of non-cardiac and traumatic origins consistently resulted in poor outcomes, highlighting the critical importance of prevention strategies to reduce the occurrence of these incidents.