Task Force Issues Recommendations on Sudden Cardiac arrest in Student Athletes
Early Access to Automated External Defibrillators Is Key to Survival
(March 14, 2007) - Philadelphia All high school and college athletic programs should develop a plan for responding to sudden cardiac arrest (SCA) in athletes, emphasizing prompt access to automated external defibrillators (AEDs), according to recommendations published in the March issue of the Clinical Journal of Sport Medicine.
"The increasing presence of and timely access to AEDs at sporting events provides a means of early defibrillation and the potential for effective secondary prevention of sudden cardiac death," comments Dr. Jonathan A. Drezner of University of Washington, lead author of the new report. The recommendations were developed by a Task Force of representatives from major athletic training, sports medicine, and other professional associations, sponsored by the National Athletic Trainers' Association.
"Sudden cardiac arrest is the leading cause of death in young athletes. Although the true rate is unknown, sudden death may occur in 110 young competitive athletes each year in the United States-about one death every three days. Vigorous exercise can trigger lethal heart rhythm abnormalities (arrhythmias) in athletes with unsuspected heart defects, such as thickening of the heart muscle (called hypertrophic cardiomyopathy). This and other conditions that predispose to SCA are not detected by routine preparticipation physical examinations. Other cases of SCA result from blunt trauma to the chest.
The new recommendations call for every school or other institution sponsoring athletic activities to develop a written and structured Emergency Action Plan for responding to SCA. A key consideration is timely access to defibrillation-delivery of an electric shock to re-establish normal heart rhythm.
The increasing availability of AEDs in public places and emergency vehicles makes it feasible to perform early defibrillation in collapsed athletes with SCA, which greatly increases the chances of survival. For every minute defibrillation is delayed, the chances of survival decrease by seven to ten percent. The Task Force writes, "Access to early defibrillation is essential, and a target goal of less than 3 to 5 minutes from the time of collapse to the first shock is highly recommended."
An Emergency Action Plan should be developed for each venue in which sporting events are held, in coordination with local emergency services. Core elements of the plan include establishing an efficient communication system, training of "first responders" in CPR and AED use, and acquiring necessary emergency equipment. Once developed, the Emergency Action Plan should be reviewed and practiced at least annually.
The Task Force also outlines uniform protocols for the management of SCA, based on current American Heart Association guidelines. The key elements of response are early access to Emergency Medical Services (calling 911); early CPR and defibrillation, if needed; and transferring the patient to advanced cardiac life support as soon as possible.
"A collapsed athlete who is also unresponsive should be treated as a potential cardiac arrest until either spontaneous breathing and a pulse is documented or the cardiac rhythm is analyzed," otherwise, according to the recommendations. Fortunately, most athletes who collapse will not be in cardiac arrest. However, many of the conditions that can mimic SCA-such as heat stroke or seizures-are also potentially serious and require emergency medical evaluation.
The article in the Clinical Journal of Sport Medicine provides detailed recommendations on information on preparing for and responding to SCA, including a checklist for creating an Emergency Action Plan and a flowchart for the management of SCA. "The most important factor in SCA survival is the presence of a trained rescuer who can initiate CPR and has access to early defibrillation," the Task Force concludes. "Comprehensive emergency planning is needed for high school and college athletic programs to ensure an efficient and structured response to SCA."
About Clinical Journal of Sport Medicine
Clinical Journal of Sport Medicine (www.cjsportmed.com) is an international refereed journal published for clinicians with a primary interest in sports medicine practice. The journal publishes original research and reviews covering diagnostics, therapeutics, and rehabilitation in healthy and physically challenged individuals of all ages and levels of sport and exercise participation. Clinical Journal of Sport Medicine is the official journal of the American Medical Society for Sports Medicine, the American Osteopathic Academy of Sports Medicine, the Australasian College of Sports Physicians, and the Canadian Academy of Sport Medicine.
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