Sudden Cardiac Arrest in Athletes
Abstract & Commentary
Synopsis: Sudden cardiac arrest survival rates can be improved with decreased response times by trained target responders.
Source: Terry GC, et al. Sudden cardiac arrest in athletic medicine. Journal of Athletic Training. 2001;36(2):205-209.
Sudden death in athletes can result from direct or indirect causes. Direct causes are traumatic, such as closed-head injury, while the major indirect cause is from an arrhythmia resulting in sudden cardiac arrest. In this article, Terry and associates emphasize the importance of decreasing response time by a trained- target responder to increase survival rates among athletes experiencing sudden cardiac arrest.
Sudden cardiac arrest in athletes is unusual, yet typically occurs in the absence of pre-event symptoms. The majority of cases of sudden cardiac arrest occur during or immediately after a training session or athletic event. The primary causes of sudden cardiac arrest are hypertrophic cardiomyopathy (36%); hypertrophic cardiomyopathy-like structural changes (10%); anomalous origin of the left main coronary artery (10%); other coronary anomalies (9%); myocarditis (6%); ruptured aortic aneurysm (5%); tunneled left anterior descending artery (5%); aortic valve stenosis (4%); dilated cardiomyopathy (3%); and arrhythmogenic right ventricular dysplasia (2%).
Prevention of cardiac causes of sudden cardiac arrest should include a thorough history and cardiac examination as part of the preparticipation examination.1 Risk factors deserving of more thorough evaluation, such as a 12-lead electrocardiogram and/or echocardiogram, include history of chest pain; shortness of breath or arrhythmia; history of cardiac problems requiring medication; and family history of death due to sudden cardiac arrest at a young age.
The effective treatment of sudden cardiac arrest depends on a sequence of events known as a "chain of survival." This chain includes: 1) prompt emergency medical system activation; 2) early cardiopulmonary resuscitation (< 2 minutes); 3) early defibrillation (2-4 minutes); 4) early advanced life support (< 8 minutes); and 5) late advanced life support. The first 4 links are especially important to the sports medicine team, and survival rates can be significantly increased with prompt activation of this chain.
Comment by David H. Perrin,, PhD, ATC
The chances of survival of a person experiencing sudden cardiac arrest declines by 5-10% each minute the condition is left untreated. The most important components of early treatment are early CPR and early defibrillation by a first responder trained in basic life support. It has been reported that 95% of patients receiving defibrillation shock in the first minute of cardiac arrest survive.
Automated external defibrillators (AED) should be readily available in every athletic medicine program. The cost of a basic LIFEPAK 500 (Medtronic Physio-Control, Redmond, Wash) AED is approximately $3000. Terry et al recommend that the athletic medical staff, including certified athletic trainers and team physicians, be involved in target-responder training as a satellite target-responder group in the EMS plan of the school and community. They further recommend that this plan include availability of automated external defibrillators that ensure response by the athletic medical team’s target responders with an AED in less than 2 minutes. They also recommend that the cost of the plan, to include acquisition of AEDs, should be a financial project of the university or school, and not a budget item of the athletic department.
This paper is a further reminder of the importance of a well-designed and rehearsed medical emergency plan for every athletic care medical team. As related to sudden cardiac arrest, the first 4 components of this plan should proceed with near simultaneous activation of EMS with a practiced response time of less than 8 minutes to early advanced life support. Not all cases of sudden death in athletes can be prevented, but team physicians and certified athletic trainers must be properly trained and prepared to deal with the rare, but potentially devastating occurrence of sudden cardiac arrest in athletes.
Reference
1. American Heart Association. Cardiovascular preparticipation screening of competitive athletes. Med Sci Sports Exerc. 1996;28:1445-1452.
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