Abstract 11133: Out-Of-Hospital Cardiac Arrest in Elementary and Middle School Students in the Era of Public-Access Defibrillation: A Retrospective, Nationwide, Hospital-Based Survey in Japan
Background: Out-of-hospital cardiac arrests (OHCA) in elementary and middle school students in the era of public-access AED is uncharacterized.
Methods: We conducted a nationwide, retrospective, hospital-based survey of such students who had OHCA of cardiac origin and received pre-hospital CPR during 2005-9 in Japan.
Results: 58 cases (median age:12yo, male ratio:63.8%) were recruited: 89.7% were witnessed by bystanders; 85.7% had ventricular fibrillation (VF) as the initial rhythm; 74.1% received bystander CPR; 75.8% received AED-based pre-hospital defibrillation (51.7% by emergency medical service personnel and 24.1% by bystanders). As the outcome, 53.4% exhibited a favorable neurological outcome 1 month after OHCA, defined as cerebral performance category 1 or 2 (CPC1-2). Underlying cardiac diseases included congenital heart diseases (CHD) (n=10), myocardial diseases, including 8 hypertrophic cardiomyopathy (HCM) (18), arrhythmic disorders, including 9 long QT and 3 CPVT (17), coronary anomaly (7) and undiagnosed ones (6). The proportion of VF among these disease categories was comparable. OHCA at school accounted for 55.2%. In univariate and multivariate analyses, an arrest at school was associated with CPC1-2 (68.8 vs 34.6% out of school, p=.017), and independently associated with CPC1-2 (p<.05, 3.402 [1.003-11.537]). An arrest patient was more likely to be initially shocked by a bystander’ AED (37.5 vs 7.7%, p=.012) at school than out of school. Exercise-related OHCA accounted for 62.1%: of which the proportion was higher at school than out of school (84.4 vs 36.8%, p<.001). Events in 7/7of coronary anomaly and 2/3 of CPVT, as well as 8/10 of other arrhythmias in the daytime, were exercise-related, while only 4/10 of CHD, 4/8 of HCM, and 6/10 of other myocardial diseases were exercise-related. OHCA with a follow-up before the event accounted for 48.3%. All the cases of CHD and 6/8 of HCM had been followed-up, while none of coronary anomaly or CPVT had been followed-up.
Conclusions: An arrest at school was associated with exercise and bystander's AED use, and was independently associated with CPC1-2. School-based AED, and management of followed-up cases, may have complementary roles in optimizing outcomes in overall school students after OHCA.
- © 2011 by American Heart Association, Inc.