October is Sudden Cardiac Arrest, or SCA, Awareness Month. Sponsored by the Heart Rhythm Society, the effort is intended to “help the public become more familiar with what (SCA) is, how it affects people, and what can be done to help save lives.”
Perhaps not coincidentally, the medical journal Sports Health last month published online a study entitled, “Survival after exercise-related sudden cardiac arrest in young athletes: Can we do better?” The article should appear in print next month.
Before revealing the answer provided by the story’s authors, perhaps it would be better to define what SCA is.
And what it is not.
First, SCA is not the same as a heart attack. However, a heart attack may cause SCA. A heart attack or myocardial infarction (MI) is caused by a blockage in a blood vessel of the heart. The heart tissue supplied by that blocked vessel is then starved of oxygen and starts to die. Depending on the area of the heart affected, cardiac arrest may ensue, However, heart attacks often do not cause cardiac arrest, especially if treated promptly.
On the other hand, numerous heart conditions beyond MI will trigger an electrical disruption (arrhythmia) that is significant enough to cause cardiac arrest. Once the heart stops beating — and therefore stops supplying blood to itself and the brain — death is imminent in minutes.
Typically, the arrhythmia associated with SCA is ventricular fibrillation, where the muscle tissue of the ventricles (the two main chambers of the heart) stops contracting in a coordinated and forceful manner and instead quivers, resembling a bag of worms.
A shock sufficient to bring the heart back into rhythm is then necessary. Defibrillators were once available only in hospitals and ambulances. Today though, automated external defibrillators or AEDs are common in airports, malls, large office buildings, and — as required by law — health clubs.
Yet, they are not specifically mandated in Indiana at schools or athletic arenas/fields. However, anyone reading the article in Sports Health will have no choice but to conclude that we can do better.
Looking at 132 cases of SCA among young athletes between 2014 and 2016, researchers from the University of Washington and University of North Carolina tallied the survival rate.
Nationwide, the average person who experiences SCA has only a 5 percent chance of surviving. Nonetheless, the subjects in this study did better with 64 (48%) surviving to discharge from a hospital. Undoubtedly, their youth (ages 11-27) played a part. Still, the researchers dug deeper to determine the whys of occurrence, success and failure.
The answers came quickly. The vast majority of the incidents (93%) were witnessed and involved males (84%). Basketball was the most dangerous sport accounting for “30% of cases, followed by football (25%), track/cross country (12%), and soccer (11%).”
All levels of play were implicated, with most cases occurring at the high school level (59%) but a significant number happening among middle schoolers (21%) and collegians (11%). Division I NCAA athletes had the highest survival rate at 75 percent followed by those at the high school level (54%), NAIA/Junior College (50%), middle school (43%), and NCAA Division II/III (40%).
Those numbers would suggest that resources and personnel affect survival. So would the fact that 60 percent of white athletes survived while far fewer African Americans (33%) and all minorities (31%) did.
Two statistics confirmed the resources/personnel theory: when an AED was present and used promptly, the survival rate increased to 89 percent and, whether an AED was available or not, if a certified athletic trainer was present, the survival rate was 83 percent.
Previous studies have demonstrated that the survival rate from SCA drops 10 percent for every minute that passes before defibrillation. Thus, the standard recommendation is that AEDs in athletic venues should be no more than one minute away from where needed.
The combination of an AED and certified athletic trainer worked to perfection in May at Lake Station High School when athletic trainer Taylor Shoemake successfully defibrillated Raphael “Nathan” Perry, 17, who had collapsed during an open gym basketball session.
Knowing that, it is impossible to argue with the Sports Health article’s conclusion that read, “Public access defibrillator programs should be universal in schools and youth sporting venues and have the potential to increase survival after SCA in young athletes.”
With AEDs now selling for less than $1,000, no youth sports organization has a legitimate excuse for not having one. With the significant number of deaths that take place at the junior high level, those schools have no excuse for not having the type of athletic training coverage high schools and colleges do.