Kiyohara Kosuke, Ayusawa Mamoru, Nitta Masahiko, Sudo Takeichiro, Iwami Taku, Nakata Ken, Kitamura Yuri, Kitamura Tetsuhisa
Department of Food Science, Faculty of Home Economics, Otsuma Women's University.
Department of Nutrition and Health Science, Faculty of Health and Medical Science, Kanagawa Institute of Technology.
Environ Health Prev Med. 2025;30:4. doi: 10.1265/ehpm.24-00319.
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.
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 χ tests for categorical variables and one-way analyses of variance for continuous variables.
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).
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.
目前尚缺乏对在学校监管下发生的儿童院外心脏骤停（OHCA）流行病学的全面了解。我们旨在全面描述日本小学、初中、高中和技术学院学生OHCA的特征和结局。
从SPIRITS研究中获取2008 - 2021年的OHCA数据，该研究提供了一个覆盖日本全国在学校监管下发生的OHCA的数据库。我们纳入了由紧急医疗服务人员或旁观者尝试进行复苏的病例。根据病因将病例分为三组：心脏源性、非心脏源性和创伤性。主要结局是1个月存活且神经功能良好，定义为格拉斯哥 - 匹兹堡脑功能分类为1或2级。通过对分类变量使用χ检验和对连续变量使用单因素方差分析，比较三组的人口统计学特征、事件细节和结局。
在14年的研究期间，共确认602例OHCA病例，其中430例（71.4%）为心脏源性，91例（15.1%）为非心脏源性，81例（13.5%）为创伤性。非心脏源性和创伤性病例在心脏骤停时被目击的可能性低于心脏源性病例（分别为46.2%和42.0%，而心脏源性病例为82.6%；p < 0.001）。非心脏源性和创伤性病例中旁观者进行心肺复苏的情况比心脏源性病例少见（分别为62.6%和42.0%，而心脏源性病例为82.8%；p < 0.001）。使用公共场所自动体外除颤器进行除颤在非心脏源性（3.3%）和创伤性病例（6.2%）中也显著低于心脏源性病例（59.8%；p < 0.001）。首次记录的心律为心室颤动（VF）在77.9%的心脏源性病例中出现，但在非心脏源性（5.5%）和创伤性病例（8.6%）中则少见得多（p < 0.001）。非心脏源性（6.6%）和创伤性病例（0%）1个月存活且神经功能良好的比例显著低于心脏源性病例（50.2%；p < 0.001）。
心脏源性OHCA更常与VF相关且预后相对较好。相比之下，非心脏源性和创伤性OHCA始终导致不良结局，凸显了预防策略对于减少这些事件发生的至关重要性。
