Patient outcomes of school‐age, out‐of‐hospital cardiac arrest in Japan: A nationwide study of schoolchildren as witnesses

AIM: Using the data from the All‐Japan Utstein Registry, this study evaluates the neurologically favourable patient outcomes and associated factors of out‐of‐hospital cardiac arrest (OHCA) with Japanese schoolchildren as witnesses. METHODS: We analysed 1,068 school‐age children (6–18 years old) who underwent OHCA from 2011 to 2016. Among the 1,068 cases, 179 were witnessed by schoolchildren and 889 were witnessed by other bystanders. Propensity score‐matched and logistic regression analyses were used to evaluate the outcomes and associated factors. RESULTS: The crude neurologically favourable outcome in the schoolchildren‐witnessed group was considerably higher than that in the other‐bystander‐witnessed group (19.6% versus 12.3%; P < 0.010). However, the difference was not significant in the propensity score‐matched analysis (19.6% versus 21.8%; P = 0.602). The multivariable logistic regression analyses of school‐age OHCA with schoolchildren as witnesses demonstrated that bystander cardiopulmonary resuscitation (CPR) provision (odds ratio [OR] 4.12, 95% confidence interval [CI] 1.44–11.75), shockable initial rhythm (OR 3.39, 95% CI 1.43–8.04), and defibrillation (OR 4.58, 95% CI 1.65–12.71) provided by any bystander were positively associated with favourable outcomes. By contrast, dispatcher‐assisted CPR provision (OR 0.28, 95% CI 0.11–0.70), exogenous cause (OR 0.16, 95% CI 0.03–0.86), adrenaline administration (0.25; 95% CI 0.07–0.92), and prolonged response time (OR 0.86; 95% CI 0.75–0.98) were negatively associated with favourable outcomes. CONCLUSIONS: Patient outcomes did not differ significantly between schoolchildren‐ and other‐bystander‐witnessed cases of school‐age OHCA. Although schoolchildren as witnesses might not be inferior to other bystanders in school‐age OHCA, further studies are needed to examine the effect of bystander CPR by schoolchildren and basic life support education in schools.