1
|
Malik A, Hanson J, Han J, Dolezal B, Bradfield JS, Boyle NG, Hsu JJ. Sudden cardiac arrest in athletes and strategies to optimize preparedness. Clin Cardiol 2023; 46:1059-1071. [PMID: 37493125 PMCID: PMC10540019 DOI: 10.1002/clc.24095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/07/2023] [Accepted: 07/11/2023] [Indexed: 07/27/2023] Open
Abstract
Sudden cardiac arrest (SCA) is the leading cause of death in young athletes. Despite efforts to improve preparedness for cardiac emergencies, the incidence of out-of-hospital cardiac arrests in athletes remains high, and bystander awareness and readiness for SCA support are inadequate. Initiatives such as designing an emergency action plan (EAP) and mandating training in cardiopulmonary resuscitation (CPR) and automated external defibrillator use (AED) for team members and personnel can contribute to improved survival rates in SCA cases. This review provides an overview of SCA in athletes, focusing on identifying populations at the highest risk and evaluating the effectiveness of different screening practices in detecting conditions that may lead to SCA. We summarize current practices and recommendations for improving the response to SCA events, and we highlight the need for ongoing efforts to optimize preparedness through the implementation of EAPs and the training of individuals in CPR and AED use. Additionally, we propose a call to action to increase awareness and training in EAP development, CPR, and AED use for team members and personnel. To improve outcomes of SCA cases in athletes, it is crucial to enhance bystander awareness and preparedness for cardiac emergencies. Implementing EAPs and providing training in CPR and AED use for team members and personnel are essential steps toward improving survival rates in SCA cases.
Collapse
Affiliation(s)
- Aneeq Malik
- Department of MedicineOlive View‐UCLA Medical CenterLos AngelesCaliforniaUSA
| | - Justin Hanson
- Department of Medicine, Division of CardiologyDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Janet Han
- Department of Medicine, Division of CardiologyVeterans Affairs Greater Los Angeles Healthcare System and UCLALos AngelesCaliforniaUSA
| | - Brett Dolezal
- Exercise Physiology Research Laboratory, Departments of Medicine and PhysiologyDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Jason S. Bradfield
- UCLA Cardiac Arrhythmia CenterDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Noel G. Boyle
- UCLA Cardiac Arrhythmia CenterDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Jeffrey J. Hsu
- Department of Medicine, Division of CardiologyDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
- Department of Medicine, Division of CardiologyVeterans Affairs Greater Los Angeles Healthcare System and UCLALos AngelesCaliforniaUSA
| |
Collapse
|
2
|
Carrington M, Providência R, Chahal CAA, D'Ascenzi F, Cipriani A, Ricci F, Khanji MY. Cardiopulmonary Resuscitation and Defibrillator Use in Sports. Front Cardiovasc Med 2022; 9:819609. [PMID: 35242826 PMCID: PMC8885805 DOI: 10.3389/fcvm.2022.819609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 01/04/2022] [Indexed: 11/16/2022] Open
Abstract
Sudden cardiac arrest (SCA) in young athletes is rare, with an estimated incidence ranging from 0.1 to 2 per 100,000 per athlete year. The creation of SCA registries can help provide accurate data regarding incidence, treatment, and outcomes and help implement primary or secondary prevention strategies that could change the course of these events. Early cardiopulmonary resuscitation (CPR) and defibrillation are the most important determinants of survival and neurological prognosis in individuals who suffer from SCA. Compared with the general population, individuals with clinically silent cardiac disease who practice regular physical exercise are at increased risk of SCA events. While the implementation of national preparticipation screening has been largely debated, with no current consensus, the number of athletes who will be diagnosed with cardiac disease and have an indication for implantable defibrillator cardioverter defibrillator (ICD) is unknown. Many victims of SCA do not have a previous cardiac diagnosis. Therefore, the appropriate use and availability of automated external defibrillators (AEDs) in public spaces is the crucial part of the integrated response to prevent these fatalities both for participating athletes and for spectators. Governments and sports institutions should invest and educate members of the public, security, and healthcare professionals in immediate initiation of CPR and early AED use. Smartphone apps could play an integral part to allow bystanders to alert the emergency services and CPR trained responders and locate and utilize the nearest AED to positively influence the outcomes by strengthening the chain of survival. This review aims to summarize the available evidence on sudden cardiac death prevention among young athletes and to provide some guidance on strategies that can be implemented by governments and on the novel tools that can help save these lives.
Collapse
Affiliation(s)
- Mafalda Carrington
- Department of Cardiology, Hospital do Espírito Santo de Évora, Évora, Portugal
| | - Rui Providência
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Department of Cardiology, Newham University Hospital, Barts Health NHS Trust, London, United Kingdom
- Institute of Health Informatics Research, University College London, London, United Kingdom
| | - C. Anwar A. Chahal
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Cardiovascular Division, University of Pennsylvania, Philadelphia, PA, United States
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
- Centre for Inherited Cardiovascular Diseases, WellSpan Cardiology, Lancaster, PA, United States
| | - Flavio D'Ascenzi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Alberto Cipriani
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, “G.d'Annunzio” University of Chieti-Pescara, Chieti, Italy
- Department of Cardiology, Casa di Cura Villa Serena, Città Sant'Angelo, Italy
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Mohammed Y. Khanji
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
- Department of Cardiology, Newham University Hospital, Barts Health NHS Trust, London, United Kingdom
- NIHR Biomedical Research Unit, William Harvey Research Institute, Queen Mary University, London, United Kingdom
- *Correspondence: Mohammed Y. Khanji
| |
Collapse
|
3
|
Lewandowski M. A Review of the Commercially Available ECG Detection and Transmission Systems-The Fuzzy Logic Approach in the Prevention of Sudden Cardiac Arrest. MICROMACHINES 2021; 12:mi12121489. [PMID: 34945338 PMCID: PMC8705604 DOI: 10.3390/mi12121489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/23/2021] [Accepted: 11/26/2021] [Indexed: 12/24/2022]
Abstract
Sudden cardiac death (SCD) constitutes a major clinical and public health problem, whose death burden is comparable to the current worldwide pandemic. This comprehensive review encompasses the following topics: available rescue systems, wearable electrocardiograms (ECG), detection and transmission technology, and a newly developed fuzzy logic algorithm (FA) for heart rhythm classification which is state-of-the art in the field of SCD prevention. Project “PROTECTOR”, the Polish Rapid Transtelephonic ECG to Obtain Resuscitation for development of a rapid rescue system for patients at risk of sudden cardiac arrest (SCA), is presented. If a lethal arrhythmia is detected on the basis of FA, the system produces an alarm signal audible for bystanders and transmits the alarm message along with location to the emergency medical center. Phone guided resuscitation can be started immediately because an automated external defibrillator (AED) localization map is available. An automatic, very fast diagnosis is a unique feature of the PROTECTOR prototype. The rapid detection of SCA is based on a processor characterized by 100% sensitivity and 97.8% specificity (as measured in the pilot studies). An integrated circuit which implements FA has already been designed and a diagnosis is made within few seconds, which is extremely important in ischemic brain damage prophylaxis. This circuit could be implemented in smart implants (Sis).
Collapse
Affiliation(s)
- Michał Lewandowski
- 2nd Department of Arrhythmia, National Institute of Cardiology, 04-628 Warsaw, Poland
| |
Collapse
|
4
|
Ha FJ, Han HC, Sanders P, La Gerche A, Teh AW, Farouque O, Lim HS. Sudden cardiac death related to physical exercise in the young: a nationwide cohort study of Australia. Intern Med J 2021; 53:497-502. [PMID: 34719841 DOI: 10.1111/imj.15606] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/24/2021] [Accepted: 10/22/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sudden cardiac death (SCD) during physical exercise is devastating. We aimed to evaluate causes and circumstances of exercise-related SCD in the young in Australia. METHODS We reviewed the National Coronial Information System database for deaths in Australia relating to cardiovascular disease in cases aged 10-35 years between 2000-2016. Included cases had undertaken physical exercise at time of event. We collected demographics, circumstances of death, type of physical exercise, bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use prior to ambulance arrival. RESULTS Over a 17-year period, 1,925 SCD cases were identified of which 110 cases (6%) (median age 27 years [interquartile range [IQR] 21-32 years], 92% male) were related to sports/physical exercise. Thirteen cases (12%) occurred in active athletes. Most common causes were coronary artery disease (CAD; 37%) and sudden arrhythmic death syndrome (SADS; 20%). Amongst Aboriginal and Torres Strait Islanders (n=10), all deaths were related to CAD. Australian Rules Football (24%), running/jogging (14%) and soccer (14%) were the most frequent physical exercise activities. Prior symptoms were present in 39% (chest pain 37%, presyncope/syncope 26%). Most were witnessed (87%) with bystander CPR in 70%. AED use prior to ambulance arrival was 8%. CONCLUSIONS This study demonstrates the high occurrence of CAD and SADS in SCD in the young related to physical exercise. Aboriginal and Torres Strait Islanders were disproportionately affected by CAD. Although events were commonly witnessed, AED was seldom used prior to ambulance arrival and highlights an important opportunity to improve outcomes in the post-arrest chain of survival. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Francis J Ha
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,St Vincent's Hospital Melbourne, Victoria, Australia
| | - Hui-Chen Han
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australia Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, South Australia, Australia
| | - Andre La Gerche
- St Vincent's Hospital Melbourne, Victoria, Australia.,Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Andrew W Teh
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Han S Lim
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia.,Department of Cardiology, Northern Health, Melbourne, Victoria, Australia
| |
Collapse
|
5
|
Panhuyzen-Goedkoop NM, Wellens HJ, Verbeek ALM, Piek JJ, Peters RJG. Immediate Bystander Cardiopulmonary Resuscitation to Sudden Cardiac Arrest During Sports is Associated with Improved Survival-a Video Analysis. SPORTS MEDICINE-OPEN 2021; 7:50. [PMID: 34292409 PMCID: PMC8298728 DOI: 10.1186/s40798-021-00346-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/08/2021] [Indexed: 11/21/2022]
Abstract
Background Sudden cardiac arrest (SCA) during sports can be the first symptom of yet undetected cardiovascular conditions. Immediate chest compressions and early defibrillation offer SCA victims the best chance of survival, which requires prompt bystander cardiopulmonary resuscitation (CPR). Aims To determine the effect of rapid bystander CPR to SCA during sports by searching for and analyzing videos of these SCA/SCD events from the internet. Methods We searched images.google.com, video.google.com, and YouTube.com, and included any camera-witnessed non-traumatic SCA during sports. The rapidity of starting bystander chest compressions and defibrillation was classified as < 3, 3–5, or > 5 min. Results We identified and included 29 victims of average age 27.6 ± 8.5 years. Twenty-eight were males, 23 performed at an elite level, and 18 participated in soccer. Bystander CPR < 3 min (7/29) or 3–5 min (1/29) and defibrillation < 3 min was associated with 100% survival. Not performing chest compressions and defibrillation was associated with death (14/29), and > 5 min delay of intervention with worse outcome (death 4/29, severe neurologic dysfunction 1/29). Conclusions Analysis of internet videos showed that immediate bystander CPR to non-traumatic SCA during sports was associated with improved survival. This suggests that immediate chest compressions and early defibrillation are crucially important in SCA during sport, as they are in other settings. Optimal use of both will most likely result in survival. Most videos showing recent events did not show an improvement in the proportion of athletes who received early resuscitation, suggesting that the problem of cardiac arrest during sports activity is poorly recognized.
Collapse
Affiliation(s)
- Nicole M Panhuyzen-Goedkoop
- Heart Centre, Amsterdam University Medical Centre, AMC, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands. .,Sports Medical Centre Papendal, Arnhem, the Netherlands.
| | | | - André L M Verbeek
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Jan J Piek
- Heart Centre, Amsterdam University Medical Centre, AMC, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands
| | - Ron J G Peters
- Heart Centre, Amsterdam University Medical Centre, AMC, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands
| |
Collapse
|
6
|
Fortington LV, Bekker S, Finch CF. Integrating and maintaining automated external defibrillators and emergency planning in community sport settings: a qualitative case study. Emerg Med J 2020; 37:617-622. [PMID: 32546475 PMCID: PMC7525771 DOI: 10.1136/emermed-2019-208781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 01/27/2020] [Accepted: 05/02/2020] [Indexed: 12/03/2022]
Abstract
INTRODUCTION A voluntary State Government-led programme in Victoria, Australia 'Defibrillators for Sporting Clubs and Facilities Program' ran from 2015 to 2019, broadly aimed at increasing access to automated external defibrillators (AEDs), together with a greater number of community members trained for management of medical emergencies. This study aimed to understand whether participating sport clubs/facilities had successfully integrated an AED and medical planning with other club/facility safety practices, 12 months after delivery of the programme. METHODS This was a qualitative case study of 14 sport clubs/facilities in Victoria, Australia in 2017, underpinned by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. We conducted observational audits of facilities (to locate AED placement, signage and other relevant location-specific factors) and semi-structured, face-to-face interviews with representatives of the clubs/facilities. Interview questions were designed to determine if and how the related, mandated emergency management programme was adapted for the long term (embedding), whether this aligned to ongoing organisational mission (active engagement), and whether or not it was still ongoing 6 months postinitial implementation (sustainability). Data were evaluated using qualitative descriptive methodology. For reporting, descriptive summaries of the audit were combined with interview data to contextualise and visualise the sport club/facility setting and key results. RESULTS Key issues identified were accessibility and visibility of the AED, with inadequate signage and challenges identifying an efficient location for access and storage. Most interviewees reported the AED and training were received with no further actions taken towards safety planning or integration with club/facility practice. Several challenges regarding remaining up to date with training and ensuring required routine checks of the AED take place were also raised. CONCLUSIONS This study identified several challenges for community sport clubs/facilities in the implementation of an AED and medical planning programme, including where to store the AED, how to make its presence known to the community and how to integrate changes alongside other club/facility practices.
Collapse
Affiliation(s)
- Lauren V Fortington
- Exercise Medicine Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Sheree Bekker
- Department for Health, University of Bath, Bath, Somerset, UK
| | - Caroline F Finch
- Exercise Medicine Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| |
Collapse
|
7
|
O'Connor S, Whyte E, Fortington L. Are Irish Gaelic Athletic Association clubs prepared to use an AED following a sudden cardiac arrest? A cross-sectional survey. PHYSICIAN SPORTSMED 2020; 48:320-326. [PMID: 31829067 DOI: 10.1080/00913847.2019.1704666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: To identify the availability and accessibility of AEDs in Irish GAA clubs and the knowledge, willingness, and confidence of club members to use AEDs in a medical emergency. Methods: A self-report survey was completed anonymously by GAA club members (n = 267). The survey captured demographic information, previous formal AED training, awareness of AED access in their local GAA club and knowledge, confidence, and willingness to use an AED in a medical emergency and awareness of a written club emergency action plan (EAP). Descriptive statistics were used to examine survey responses and independent samples t-tests to compare differences in outcome scores between those who have or have not completed formal AED training and those that have or have not studied toward or worked in a health-care provision role. Results: Three in every five GAA club members reported that their club owned an AED and almost half of all respondents had access to a club AED in the event of a medical emergency in their club. Formal training was noted by 53.2% of respondents; this group demonstrated significantly better knowledge, confidence, and willingness (p < 0.0001) than those without. Few (7%) respondents knew where the club EAP was or how to access it. Conclusion: To ensure the chain of survival works effectively it is essential that an AED is available, is accessible, and that club members know its location, know when to use it, and are willing and confident to use it. GAA clubs should design an individual emergency action plan and disseminate it widely among club members. Formal AED training should be encouraged among club members and at least one trained member should be present during all club activities.
Collapse
Affiliation(s)
- Siobhán O'Connor
- School of Health and Human Performance, Dublin City University , Dublin, Ireland
| | - Enda Whyte
- School of Health and Human Performance, Dublin City University , Dublin, Ireland
| | - Lauren Fortington
- Exercise Medicine Research Institute, School of Medical and Health Science, Edith Cowan University , Joondalup, Australia
| |
Collapse
|