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

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.