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  • Population Study Article
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Association between suicide attempts and pediatric OHCA survival during the COVID-19 pandemic: Japanese cohort study

Pediatric Research (2024)Cite this article

Abstract

Background

Suicide is a leading cause of death in children. The COVID-19 pandemic might change the characteristics, causes (medical, suicidal, accidental, and other non-medical), and outcomes of pediatric OHCA. This study aimed to investigate the impact of pediatric OHCA in age, location, and quarantine-related movement restriction subgroups.

Methods

Combining the nationwide OHCA registry with the emergency medical service transportation database, we created a database with detailed information on 7657 non-neonatal, pediatric OHCA cases.

Results

The pandemic period did not significantly alter neurologically favorable 1-month survival compared to pre-pandemic 4 years (95% confidence interval 0.73-1.00). However, the survival rate significantly decreased in the following subgroups of OHCA: school-age (0.62–0.96), outside of school or home (0.52–0.96), and cases where no quarantine-related movement restrictions were applied (0.68–0.97). There was a prominent increase in the proportion of suicide-related OHCA in these subgroups: from 30.3 to 38.1% (1.22–1.64), from 10.2 to 15.9% (1.21–2.28), and from 12.5 to 17.8% (1.30–1.77), respectively.

Conclusion

The COVID-19 pandemic did not significantly alter neurologically favorable 1-month survival. However, it led to worsened survival in subgroups with higher suicide attempt rates. Prevention of suicide is likely essential in the assurance of children’s lives during the pandemic.

Impact

  • This cohort study found that during the 2020/2021 pandemic, neurologically favorable survival decreased in school-age out-of-hospital cardiac arrest (OHCA) cases, those not subject to quarantine-related movement restrictions, and those in locations outside of school or home.

  • Within these three subgroups, there was a notable rise in OHCA cases related to suicide, historically known to be more challenging to manage successfully.

  • However, survival rates for overall OHCA and medically related OHCA cases remained unchanged throughout the pandemic.

  • Preventive measures for suicide attempts may be necessary to improve the overall survival of pediatric OHCA during the pandemic.

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Fig. 1: Data selection and overview.
Fig. 2: Trends of BCPR and DA-CPR.
Fig. 3: Trend of neurologically favorable 1-month survival.
Fig. 4: Comparison of neurologically favorable 1-M survival in subgroups.

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Data availability

Data may be obtained from a third party and are not publicly available. Registry data may be available with permission of the FDMA.

References

  1. Marijon, E. et al. Out-of-hospital cardiac arrest during the COVID-19 pandemic in Paris, France: a population-based, observational study. Lancet Public Health 5, e437–e443 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  2. Rosell Ortiz, F. et al. Influence of the COVID-19 pandemic on out-of-hospital cardiac arrest. A Spanish nationwide prospective cohort study. Resuscitation 157, 230–240 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  3. Baldi, E. et al. Out-of-hospital cardiac arrests and mortality in Swiss cantons with high and low covid-19 incidence: a nationwide analysis. Resuscitation 6, 100105 (2021).

    Article  Google Scholar 

  4. Chan, P. S. et al. Outcomes for out-of-hospital cardiac arrest in the United States during the coronavirus disease 2019 pandemic. JAMA Cardiol. 6, 296–303 (2021).

    Article  PubMed  Google Scholar 

  5. Scquizzato, T. et al. Effects of COVID-19 pandemic on out-of-hospital cardiac arrests: a systematic review. Resuscitation 157, 241–247 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  6. Scquizzato, T. et al. Impact of COVID-19 pandemic on out-of-hospital cardiac arrest system-of-care: a systematic review and meta-analysis. Prehosp. Emerg. Care 26, 30–41 (2022).

    Google Scholar 

  7. Bielski, K. et al. The Influence of COVID-19 on out-hospital cardiac arrest survival outcomes: an updated systematic review and meta-analysis. J. Clin. Med. 10, 5573 (2021).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Couper, K. et al. Covid-19 in cardiac arrest and infection risk to rescuers: a systematic review. Resuscitation 151, 59–66 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  9. Edelson, D. P. et al. Interim guidance for basic and advanced life support in adults, children, and neonates with suspected or confirmed covid-19: from the Emergency Cardiovascular Care Committee and get with the guidelines-resuscitation adult and pediatric task forces of the American Heart Association. Circulation 141, e933–e943 (2020).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Zha, L., Hosomi, S., Kiyohara, K., Sobue, T. & Kitamura, T. Association of the Covid-19 pandemic with prehospital characteristics and outcomes of pediatric patients with out-of-hospital cardiac arrest in Japan, 2005-2020. JAMA Netw. Open 5, e2235401–e2235401 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  11. Chen, C. Y. et al. Impact of coronavirus disease 2019 pandemic on pediatric out-of-hospital cardiac arrest in the emergency department. Front. Pediatr. 10, 846410 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  12. Dhungel, B. et al. Method-specific suicide trends from 1979 to 2016 among Japanese Adolescents. J. Affect. Disord. 310, 129–134 (2022).

    Article  PubMed  Google Scholar 

  13. The Japan Times [Internet]. Japan Sees Record High of 512 Student Suicides in 2022., <https://www.japantimes.co.jp/news/2023/03/02/national/social-issues/school-children-suicides/> (2023).

  14. Pathirathna, M. L., Nandasena, H. M. R. K. G., Atapattu, A. M. M. P. & Weerasekara, I. Impact of the Covid-19 pandemic on suicidal attempts and death rates: a systematic review. BMC Psychiatry 22, 506 (2022).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Jacobs, I. et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries. a statement for healthcare professionals from a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council, Heart and Stroke Foundation of Canada, Interamerican Heart Foundation, Resuscitation Council of Southern Africa). Resuscitation 63, 233–249 (2004).

    Article  PubMed  Google Scholar 

  16. Jennett, B. & Bond, M. Assessment of outcome after severe brain damage. Lancet 1, 480–484 (1975).

    Article  CAS  PubMed  Google Scholar 

  17. Song, P., Mitsuya, H. & Kokudo, N. Covid-19 in Japan: an update on national policy, research, clinical practice, and vaccination campaign. Glob. Health Med. 4, 64–66 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  18. Murasaka, K., Yamashita, A., Owada, H., Wato, Y. & Inaba, H. Association between the types of bystander cardiopulmonary resuscitation and the survival with good neurologic outcome of preschool pediatric out-of-hospital cardiac arrest cases in japan: a propensity score matching analysis using an extended nationwide database. Front. Pediatr. 10, 1075983 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

  19. Fire and Disaster Management Agency (Japan) [Internet]. Koutousidou Ni Kansuru Zisshikizyun No Itibu Kaiseinado Ni Tuite, <https://www.fdma.go.jp/laws/laws/laws017.html> (2013).

  20. Nolan, J. P. et al. European Resuscitation Council covid-19 guidelines executive summary. Resuscitation 153, 45–55 (2020).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Yap, J. et al. Temporal trends of suicide-related non-traumatic out-of-hospital cardiac arrest characteristics and outcomes with the COVID-19 pandemic. Resusc 9, 100216 (2022).

    Google Scholar 

  22. Lee, S. Y. et al. Trends of the incidence and clinical outcomes of suicide-related out-of-hospital cardiac arrest in Korea: a 10-year nationwide observational study. Resuscitation 163, 146–154 (2021).

    Article  PubMed  Google Scholar 

  23. Ministry of Health, Labour and Welfare (Japan) [Internet]. Reiwa 4nenzyuuniokeru Zisatu No Zyoukyou, <https://www.mhlw.go.jp/content/R4kakutei01.pdf> (2023).

  24. World Health Organization. Suicide worldwide in 2019 (World Health Organization, Geneva, 2021).

  25. Kauhanen, L. et al. A systematic review of the mental health changes of children and young people before and during the covid-19 pandemic. Eur. Child Adolesc. Psychiatry 32, 995–1013 (2023).

    Article  PubMed  Google Scholar 

  26. Gunnell, D. et al. Suicide risk and prevention during the COVID-19 pandemic. Lancet Psychiatry 7, 468–471 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  27. Ann, J., Jane, P., David, G., Louis, A. & Jacqui, M. Trends in suicide during the covid-19 pandemic. BMJ 371, m4352 (2020).

    Google Scholar 

  28. Yoshioka, E., Hanley, S. J. B., Sato, Y. & Saijo, Y. Impact of the Covid-19 pandemic on suicide rates in Japan through December 2021: an interrupted time series analysis. Lancet Reg. Health West Pac. 24, 100480 (2022).

    PubMed  PubMed Central  Google Scholar 

  29. Madigan, S. et al. Comparison of paediatric emergency department visits for attempted suicide, self-harm, and suicidal ideation before and during the COVID-19 pandemic: a systematic review and meta-analysis. Lancet Psychiatry 10, 342–351 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

  30. Adult and Child Chain of Survival Infographic [Internet], <https://newsroom.heart.org/file?fid=642c498bb3aed3241dd7976d> (2020).

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Acknowledgements

We want to thank the Fire and Disaster Management Agency of Japan for providing the necessary data. Also, we would like to thank Mr. Yoshiki Sato and Mr. Rui Hitai, undergraduate students at Niigata University of Health and Welfare, for their assistance in creating the Tables and Figures. This study received no funding from any agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Emergency Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, 920-0293, Japan

    Kento Nakajima, Tomoyuki Ushimoto & Hideo Inaba

  2. Department of Emergency Medical Science, Niigata University of Health and Welfare, 398 Shimami-cho, Kita-ku, Niigata-shi, Niigata, 950-3198, Japan

    Koichi Tanaka, Maria Takagi & Hideo Inaba

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  1. Kento Nakajima
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Contributions

K.N. and K.T. contributed equally to this article as the first authors. Conceptualization and study design, K.N. and H.I.; data acquisition, H.I.; data analyses and interpretation, K.N., K.T., and H.I.; manuscript drafting, K.N. and T.U.; manuscript revision for intellectual content, K.N. and H.I. All authors have read and approved the final version of the manuscript.

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Correspondence to Kento Nakajima.

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Nakajima, K., Tanaka, K., Takagi, M. et al. Association between suicide attempts and pediatric OHCA survival during the COVID-19 pandemic: Japanese cohort study. Pediatr Res (2024). https://doi.org/10.1038/s41390-024-03290-5

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