Sports-Related Out-of-Hospital Cardiac Arrest due to External Causes, Including Commotio Cordis, at Schools in Japan.

INTRODUCTION

To describe the characteristics and outcomes of sports-related out-of-hospital cardiac arrest (OHCA) due to external causes, including commotio cordis, during school-supervised sports activities in Japan's elementary schools, junior high schools, high schools, and technical colleges.

METHODS

OHCA data (2008-2022) were obtained from the Stop and Prevent cardIac aRrest, Injury, and Trauma in Schools (SPIRITS)-a nationwide database of OHCAs occurring under school supervision across Japan. We identified sports-related OHCAs with external causes and summarized patients' characteristics, bystander interventions, available response intervals, and survival outcomes.

RESULTS

We identified 30 sports-related OHCA cases due to external causes. The most frequently played sports were soccer/futsal (n = 8), baseball (n = 8), and swimming (n = 4). The leading etiology was commotio cordis (n = 15), followed by drowning (n = 8). Among the 15 cases meeting our operational definition of commotio cordis, automated external defibrillator (AED) pads were applied in 14 (93%), shocks were delivered in 13 (87%), and 12 (80%) achieved a favorable neurological outcome. Among other external causes (n = 15), ventricular fibrillation occurred in 4/15 (27%), AED pads were applied in 7/15 (47%), shocks were rare (1/15, 7%), and 1/15 (7%) achieved favorable neurological outcomes.

CONCLUSIONS

Nationwide case-level reconstruction revealed distinct mechanism-to-response pathways. Although these descriptive data cannot establish the causal effects of the public access defibrillation programs or other interventions on outcomes, they highlight potentially actionable, mechanism-specific opportunities for emergency response and prevention.