Out-of-hospital cardiac arrest in school sports in Japan: Possible next steps

Out-of-hospital cardiac arrest in school sports in Japan: Possible next steps To the Editor,The recent publication by Kiyohara et al. 1 is an exciting addition to the literature pertaining to out-of-hospital sudden cardiac arrest (SCA) and the utility of immediate cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) implementation.This publication contributes to other data regarding defibrillation in school sports and confirms that the availability of AEDs assists in youth survival from SCA. 2 Additionally, this report found the rate of CPR being used in conjunction with AEDs in youth sport increased from 65.8% to 89%, a reassuring statistic for public defibrillation efforts in saving lives. 1 Recent reviews of SCA in sport have identified a sustained lack of knowledge about SCA risk across various activities and regions, 3 thus this study will provide critical information to fill the gap about youth SCA incidence and survival across many activities.This paper found that approximately 4.7% of SCA cases in this cohort were due to non-cardiac origins. 1 Unfortunately, the authors did not identify what the specific non-cardiac etiologies of SCA were, possibly due to an inability to obtain that information.There is significant variability in the etiologies of SCA in youth athletes, likely due to ascertainment bias, regional variation, and clinical variation.4 Therefore, reporting these causes in future research would contribute greatly to the gaps in knowledge of youth SCA origins.Moreover, this study found lower combined CPR and AED use in the non-cardiac originated cases.Commonly stemmed from non-cardiac origins like hypoxia, non-shockable rhythms of SCA, such as asystole, are strongly associated with poor outcomes and require prompt treatment of the underlying etiology. 5Though defibrillation does not cease the erratic dysrhythmia in this population, AEDs can still be used to monitor changes in rhythm during ongoing resuscitation, allowing providers continuous insight into how to treat the affected patient and in special circumstances where travel to a hospital is unavailable.6,7 Therefore, it is important to reiterate that though AEDs are not being used as often for non-cardiac origins of SCA, they may still serve an important role in this relatively smaller population to improve outcomes.Interestingly, this article did not mention the status of an emergency action plan (EAP) at schools, which have been previously recommended in places of sport.8 Identifying the presence and impact