Cardiac Safety: Best Practices For Preventing Sudden Cardiac Death In Sports

Authors: 

Lindsey Barton Straus, JD

Sudden cardiac arrest (SCA) is an electrical malfunction of the heart, disrupting the heart muscle's normal rhythm, causing the heart muscle to twitch spasmodically. The heart then loses its ability to effectively pump blood. This activity is called ventricular fibrillation (VF).

Because the heart is not pumping blood, a person in VF usually has no detectable pulse. They suddenly collapse, become unresponsive, and stop breathing or breathe abnormally (gasping, labored breathing). Brief seizure-like activity is common in athletes with SCA. If untreated, this abrupt loss of heart function results in sudden cardiac death within minutes of onset.

SCA is the leading cause of sudden death in youth athletes, usually from an undetected heart condition (such as hypertrophic cardiomyopathy) or from an ill-timed blow to the chest (a condition called commotio cordis).  In order to minimize death from SCA, not just of athletes but of game officials, coaches, and spectators, best youth sports safety practices require the following:

Pre-participation screening. Athletes should undergo cardiovascular screening before participation in competitive athletics. Screening should, at minimum, include the taking of a comprehensive personal history, family history, and physical examination. Athletes who experience cardiovascular symptoms during sports should be evaluated by a physician and require medical clearance before returning to sport participation. Patients with an identified cardiac disorder, unexplained symptoms, or previous sudden death events should be cleared by a cardiologist before returning to sport participation is considered.  While electrocardiogram screening (ECG) is common in other countries, it has not the standard of care in the United States.

On-site availability of AED: An automatic external defibrillator (AED) should be on site and readily available within 3 minutes (with 1 minute being ideal) for all practices and games.

Annual AED training: Coaches, athletic trainers, and volunteers should be educated annually about the location, function and use of AEDs.

Proper management of SCA victims (Cardiac Chain of Survival)  The Chain of Survival is a five-step process for providing treatment to SCA victims of sudden cardiac arrest 

1. Prompt recognition of SCA. Determine that the victim has experienced a cardiac arrest, based on unresponsiveness and lack of normal breathing.

2. Immediate activation of the emergency response system.  An immediate call to 911 is crucial; the sooner 911 or your local emergency number is called the sooner early advanced life support arrives. A delay of just a few minutes could prove fatal.

3. Early CPR. Once an SCA victim collapses and a bystander calls 911, the next step in the chain is to immediately begin chest compressions (Cardiopulmonary Resuscitation or CPR).  The American Heart Association now recommends that all rescuers, regardless of training, or skill level, victim characteristics, or available resources, should provide chest compressions to all cardiac arrest victims, with rescuers who are able adding ventilations (mouth-to-mouth) to chest compressions. Rescuers should start CPR immediately.  The directive to "look, listen, and feel for breathing" is no longer recommended.  The focus should be on delivering high-quality CPR:

  • providing chest compressions of adequate rate (at least 100-120/minute)
  • providing chest compressions of adequate depth
  • adults: a compression depth of at least 2 inches
  • infants and children: a depth of at least 1 1/2 inches in infants and about 2 inches in children
  • allowing complete chest recoil after each compression
  • minimizing interruptions in compression
  • avoiding excessive ventilation
 
4. Early Defibrillation. Most victims of SCA need an electric shock called defibrillation to restore the heart to a regular rhythm.  When the AED arrives, apply the pads, if possible, without interrupting chest compressions and turn the AED on.  The AED will analyze the rhythm and direct the rescuer either to provide a shock (i.e. attempt defibrillation) or to continue CPR.  Defibrillation outcomes improved when interruptions in chest compressions kept to minimum. This is the most critical link: Although CPR can sustain life for a short time, it must be followed within minutes by early defibrillation. Each minute that defibrillation is delayed reduces the victim's chance of survival by about 10 percent. Almost a third of the deaths from sudden cardiac arrest can be prevented if an AED id available for immediate use at the time of the emergency. Unfortunately, AEDs are not yet widely in use, especially in schools and by youth sports programs. As a result, many youth sports athletes die each year that might have been saved by an AED. 
 
5. Transport/Early Advanced Life Support. Paramedics and other highly trained EMS personnel provide this care, which can include basic life support, defibrillation, administration of cardiac drugs, and the insertion of endotracheal breathing tubes (intubation), which helps maintain normal heart rhythm after defibrillation: Advanced care can help the heart in VF respond to defibrillation and maintain a normal rhythm after successful defibrillation, and allows monitoring on the way to the hospital: The trained EMS personnel monitor the patient closely on the way to the hospital, where more definitive diagnostic evaluation can occur.
 
Saves lives
 
Following the Cardiac Chain of Survival dramatically increases the survival rates for SCA victims:
  • CPR and AED used within 8 Minutes: When CPR and defibrillation are provided within eight minutes of an episode, a person's chance of survival increases to 20%.
  • CPR and AED Within 4 Minutes/EMS Within 8 Minutes: When these steps are provided within four minutes and a paramedic arrives within eight minutes, the likelihood of survival increases to over 40%.
  • Defibrillation Within 5 To 7 Minutes: 49% Survival Rate. According to the AHA, the survival rate from SCA is as high as 49% where defibrillation occurs within 5 to 7 minutes of collapse. Survival rates between 70 and 89% were recently reported at U.S. high schools with AEDs.
If nothing is done for a cardiac arrest victim, he is probably going to die. Even with prompt CPR he is probably going to die before the ambulance arrives. Defibrillation applied shortly after his collapse gives him a fair chance of survival. What better reason could there be for implementing AED programs?
 
For more about starting an AED program, click here.