Impact of 2020 COVID-19 pandemic on bystander reaction to and outcomes of pediatric out-of-hospital cardiac arrest in Japan: a population-based, nationwide cohort study

Abstract Background To clarify the impact of the 2020 COVID-19 pandemic on bystanders’ response to and outcomes of pediatric out-of-hospital cardiac arrest (OHCA)| in Japan. Methods Prospectively collected nationwide population-based data, including detailed location information, of 9,212 pediatric (age ≤ 18 years) OHCA cases recorded between 2017 and 2020 were combined with another database. After excluding 610 emergency medical service (EMS)- and physician-witnessed cases, 62 cases without any prehospital resuscitation effort, and 430 newborns, 7,582 patients were finally analyzed. The primary outcome was neurologically favorable 1-month survival (cerebral performance category = 1 or 2). We examined detailed variations in OHCA characteristics and outcomes between the pre-pandemic and pandemic years with consideration of phase, and witness status. Results The pandemic year 2020 was considerably associated with higher rates of neurologically favorable 1-month survival rate, bystander cardiopulmonary resuscitation (BCPR), advanced compliance to DA-CPR (dispatcher-assisted CPR), and higher proportions of witnessed OHCA, outdoor OHCA, and compression-only BCPR. The pandemic year was associated with a lower incidence of DA-CPR attempt in care/education facilities, and a higher incidence of DA-CPR during the temporary school closure. The association of the pandemic year with better outcomes and higher bystander’s own activities for CPR in witnessed OHCA were statistically stronger than those in unwitnessed OHCA. Improvements in the survival rate in 2020 were significant in locations other than childcare/education facilities and for witnessed OHCA and OHCA during days other than temporary school closure. Worsening of outcomes was not observed in any subgroup. he superiority of conventional BCPR to compression-only BCPR in neurologically favorable outcomes were enhanced in 2020. Conclusions The COVID-19 pandemic in 2020 was associated with better outcomes of OHCA in children. Significant enhancements of favorable outcomes were observed in witnessed cases. The heightened preparedness for health crises in communities may have contributed to better outcomes during this pandemic compared to pre-pandemic years. In addition, during this pandemic, the benefits of conventional CPR were further enhanced.