Cardiac arrest in schools: Nationwide incidence, risk, and outcome

Schools are an important location for improving OHCA outcome. But there are few data on out of hospital cardiac arrest (OHCA) in schools. This study aimed to show incidence and outcome of OHCA in schools, specifying location and activities.

We used the Korean nationwide OHCA registry from 2008 to 2014. OHCA victims were categorized regarding level of school. The average annual incidence of OHCA was calculated based on per 1000 schools. The epidemiological characteristics are analysed and location and activity at the time of arrest is further described. The outcome of OHCA victims were analysed.

511 OHCA occurred in school while 374 cases were cardiac origin, 125 cases were non-cardiac, and 12 cases were missing in information. Annual incidence was 5.72 per 1000 school while highest incidence was shown in university (11.02 per 1000 school). The majority of victims were male (84.1%), aged 19-64 (62.2%, median 44.75), either students (35.0%) or visitors (35.2%). Most victims had none shockable rhythms, did not received EMS defibrillation and were not witnessed arrests, while most received bystander CPR. A large proportion of arrests occurred at an outdoor campus (29.7%) or sports facility (28.8%), and the most frequent activity was exercise (30.7%). 100 patients (19.6%) survived to discharge, and 66 patients (12.9%) were discharged with good neurological outcome.

Incidence of OHCA in school is low. Most of victims were adult visitors. About one third of OHCA occurred during sports activity or at the sports facility.