Incidence, characteristics, and outcomes of pediatric out-of-hospital cardiac arrest in nursery schools and kindergartens in Japan

Kosuke Kiyohara; Tetsuhisa Kitamura; Mamoru Ayusawa; Masahiko Nitta; Taku Iwami; Ken Nakata; Satoshi Matsui; Tomotaka Sobue; Yuri Kitamura; SPIRITS investigators

doi:10.1016/j.jjcc.2020.06.003

Incidence, characteristics, and outcomes of pediatric out-of-hospital cardiac arrest in nursery schools and kindergartens in Japan

J Cardiol. 2020 Dec;76(6):549-556. doi: 10.1016/j.jjcc.2020.06.003. Epub 2020 Jun 29.

Authors

Kosuke Kiyohara¹, Tetsuhisa Kitamura², Mamoru Ayusawa³, Masahiko Nitta⁴, Taku Iwami⁵, Ken Nakata⁶, Satoshi Matsui², Tomotaka Sobue², Yuri Kitamura²; SPIRITS investigators

Affiliations

¹ Department of Food Science, Faculty of Home Economics, Otsuma Women's University, Tokyo, Japan. Electronic address: kiyosuke0817@hotmail.com.
² Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Japan.
³ Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan.
⁴ Department of Emergency Medicine, Osaka Medical College, Takatsuki, Japan; Department of Pediatrics, Osaka Medical College, Takatsuki, Japan.
⁵ Kyoto University Health Service, Kyoto, Japan.
⁶ Medicine for Sports and Performing Arts, Department of Health and Sport Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan.

PMID: 32616330
DOI: 10.1016/j.jjcc.2020.06.003

Abstract

Background: A better understanding of the epidemiology of pediatric out-of-hospital cardiac arrest (OHCA) occurring in nursery schools and kindergartens is indispensable to establish an evidence-based strategy for prevention and improved outcomes. This study aimed to describe the incidence, characteristics, and outcomes of pediatric OHCAs that occurred in certified nursery schools and kindergartens.

Methods: Stop and Prevent cardIac aRrest, Injury, and Trauma in Schools (SPIRITS) is a study to construct and analyze a nationwide registry of pediatric OHCAs occurring in school settings in Japan. Using data from the SPIRITS registry, we assessed the incidence, characteristics, and outcomes of pediatric OHCAs that occurred in certified nursery schools/kindergartens between April 2008 and December 2016.

Results: During the study period, 37 OHCA patients (31 in certified nursery schools and 6 in kindergartens) were confirmed. The overall incidence rate was 0.13 per 100,000 children per year. Among 37 patients, 57% (21/37) had an OHCA while napping and 35% (13/37) experienced OHCA that was witnessed by bystanders. Although public-access automated external defibrillator pads were applied by bystanders in 24% (9/37) of cases, only 1 patient actually received defibrillation. Overall, the proportion of 1-month survival with favorable neurological outcomes after OHCA was 19% (7/37). Among those with OHCA of non-medical origins, 60% (3/5) of patients experienced arrest caused by suffocation, 60% (3/5) by drowning, and 100% (1/1) by head injury. In contrast, no patient had 1-month favorable neurological outcomes among those with OHCA of medical origins such as presumed cardiac origin (0/17), sudden infant death syndrome (0/6), acute viral myocarditis (0/1), respiratory disease (0/1), and ventricular fibrillation (0/1).

Conclusions: In this population, the majority of pediatric OHCAs occurring in certified nursery schools/kindergartens had non-ventricular fibrillation rhythm, and their outcomes after OHCA of medical origin were poor.

Keywords: Children; Kindergarten; Nursery school; Out-of-hospital cardiac arrest.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Child
Child, Preschool
Defibrillators
Female
Humans
Incidence
Infant
Infant, Newborn
Japan / epidemiology
Male
Out-of-Hospital Cardiac Arrest / epidemiology*
Out-of-Hospital Cardiac Arrest / therapy
Registries
Schools