Out-of-hospital cardiac arrest in schools: A systematic review

Background: Out-of-hospital cardiac arrest (OHCA) in children and adolescents is rare, with a minority of cases occurring at school. When OHCA does occur at school it is more likely to affect an adult than a student. Developing comprehensive strategies to treat cardiac arrest occurring at schools would be helped by accurate data regarding its epidemiology.

Methods: A systematic review was undertaken. An electronic search strategy of MEDLINE and EMBASE databases was devised and relevant papers reporting data on school-based OHCA incidence and/or outcome in both adults and children were identified. Further articles were obtained from the bibliographies of these papers and from related articles.

Results: Nine studies were included in the systematic review. Cardiac arrest incidence was one per 23.8-284.1 schools per year. Cardiac arrest incidence amongst students, reported in some studies, was 0.17-4.4 per 100,000 students per year. Studies also reported, although not universally, rates of witnessed OHCA (25.0-97.2%), VF (57.4-67.6%), bystander CPR (25.0-94.4%) and automated external defibrillator (AED) use (23.4-91.5%). Survival to hospital discharge or at one month was between 31.9% and 71.2%.

Conclusion: Cardiac arrest in schools is rare, and more likely to occur in adults than children. Outcomes are better than OHCA occurring at other locations, probably due to the high proportion of witnessed arrests and high rates of bystander CPR. It is likely that school-based AEDs will rarely be needed, but have the potential to make a dramatic impact on outcome.