What is Sudden Cardiac Arrest?What is Sudden Cardiac Arrest?
Sudden cardiac arrest is the leading cause of death among young athletesSudden cardiac arrest is the leading cause of death among young athletes
Athletes are considered the healthiest members of society, yet Athletes are considered the healthiest members of society, yet catastrophic death can occur without warning signs.catastrophic death can occur without warning signs.
SCA causes a normal heart to an fibrillation called: Ventricular Fibrillation SCA causes a normal heart to an fibrillation called: Ventricular Fibrillation
After a few minutes of VF the vital organs do not get blood flow and will After a few minutes of VF the vital organs do not get blood flow and will diedie
The heart must receive a shock from an AED to reset the electrical systemThe heart must receive a shock from an AED to reset the electrical system
An AED and CPR can quadruple survival from SCAAn AED and CPR can quadruple survival from SCA
Community AED programs are the only way to insure immediate access to Community AED programs are the only way to insure immediate access to life saving therapieslife saving therapies
The survival rate of an The survival rate of an individual declines individual declines approximately 10% for approximately 10% for every minute that passes every minute that passes without defibrillation.without defibrillation.
N.A. Mark Estes III, MD, and Mark S. Link, MD, from the Cardiac Arrhythmia Center at the Tufts Medical Center in Boston, Massachusetts. Commotio Cordis Registry (Minneapolis, Minnesota).
Commotio Cordis a cause of SuddenCardiac Death is caused by a blow to the chest directly over the heart in between beats, leading to sudden cardiac arrest.
Since 1998, more than 224 youngsters have died from this condition, according to the Commotio Cordis Registry.
Second leading cause of sudden cardiac death in young athletes.
Every Minute Every Minute Counts!Counts!
Occurs most commonly in baseball and lacrosse
Why do this?Why do this?
Don’t always have doctors and nurses on the fields Don’t always have doctors and nurses on the fields during gamesduring games
Don’t know where lightening will strikeDon’t know where lightening will strike
SCA is not so rareSCA is not so rare
SCA can happen secondary to other injuriesSCA can happen secondary to other injuries
AEDs are easy to use; don’t make mistakes AEDs are easy to use; don’t make mistakes
Anyone can help save a lifeAnyone can help save a life
IncidenceIncidence
The precise incidence of commotio cordis in The precise incidence of commotio cordis in children is children is unknown because because of the absence of of the absence of systematic and mandatory reporting, but based systematic and mandatory reporting, but based upon data from the upon data from the National Commotio Cordis Registry in Minneapolis > 224 deaths-last 12 yrsin Minneapolis > 224 deaths-last 12 yrs
It is among the most frequent cardiovascularIt is among the most frequent cardiovascular causes causes of sudden death in young athletes, after of sudden death in young athletes, after hypertrophichypertrophic cardiomyopathy and congenital cardiomyopathy and congenital coronary-artery anomaliescoronary-artery anomalies
Look at your own safetyLook at your own safety
Would you cancel your home owners insurance since you had Would you cancel your home owners insurance since you had no claims in 10 yrs?no claims in 10 yrs?
Would you cancel your health insurance since you have been Would you cancel your health insurance since you have been healthy for 10 yrs?healthy for 10 yrs?
Would you allow your children’s schools to remove fire Would you allow your children’s schools to remove fire extinguishers since they had no fires in 10 yrs?extinguishers since they had no fires in 10 yrs?
Would you remove the seatbelts from your car?Would you remove the seatbelts from your car?
Would you ride a motorcycle without a helmet?Would you ride a motorcycle without a helmet?
Would you let someone die because you were not informed or Would you let someone die because you were not informed or trained to do something simple?trained to do something simple?
Who is at Risk?Who is at Risk?
About 50% of commotio cordis events have been reported About 50% of commotio cordis events have been reported in youngin young competitive athletes (mostly those between 11 competitive athletes (mostly those between 11 and 20 years ofand 20 years of age)age)
Typically baseball, softball, ice hockey, football,Typically baseball, softball, ice hockey, football, or lacrosseor lacrosse
In baseball, for example, commotio cordis is oftenIn baseball, for example, commotio cordis is often
triggered when players are struck in the chest by balls thattriggered when players are struck in the chest by balls that
have been pitched, batted, or thrown in a variety of have been pitched, batted, or thrown in a variety of scenariosscenarios
Maron B and Estes N. N Engl J Med 2010;362:917-927
Distribution of Commotio Cordis Events According to Age and Activity
Maron B and Estes N. N Engl J Med 2010;362:917-927
Mechanism of Commotio Cordis
Maron B and Estes N. N Engl J Med 2010;362:917-927
Examples of Circumstances in Which Chest Blows Have Triggered Commotio Cordis
Is it Instantaneous?Is it Instantaneous?
Although cardiovascular collapse is virtually Although cardiovascular collapse is virtually instantaneous,instantaneous, 20% of victims remain physically 20% of victims remain physically active for a few seconds afteractive for a few seconds after the blow (e.g., the blow (e.g., continuing to walk, run, skate, throw a ball,continuing to walk, run, skate, throw a ball, or even or even speak), which may reflect individual tolerance for speak), which may reflect individual tolerance for sustainedsustained ventricular tachyarrhythmia. ventricular tachyarrhythmia.
(For example, a baseball pitcher(For example, a baseball pitcher struck in the chest by a batted ball was able to struck in the chest by a batted ball was able to retrieve theretrieve the ball at his feet, successfully complete the play (throwing outball at his feet, successfully complete the play (throwing out the the base runner), and then prepare for his next pitch beforebase runner), and then prepare for his next pitch before collapsing. collapsing.
In another instance, a batter was struck by a pitchIn another instance, a batter was struck by a pitch while attempting to bunt and while attempting to bunt and collapsed only after running tocollapsed only after running to first base.)first base.)
• Commercially available chest protectors may be inadequate in the prevention of sudden death due to commotio cordis.
• Reasons include the fact that the protector may move when the arms are raised, leaving the precordium exposed composite material the protector is made from does not adequately attenuate the blow.
• Under experimental conditions, the likelihood that ventricular fibrillation will be triggered by a projectile the size of a baseball increases progressively up to an impact velocity 40 mph, a speed typically delivered by 11- and 12-year-old pitchers.
• 224 fatal cases of commotio cordis recorded in the National Commotio Cordis Registry shows that in competitive sports, almost one third (40 of 125) of the athletes who died as a result of the event were wearing a chest barrier.
What are the Fact about Chest Protectors?
Maron B and Estes N. N Engl J Med 2010;362:917-927
Chest Protection and Commotio Cordis
Failure of Commercially Available Chest Wall Protectors To Prevent SCA. Pediatrics 2006; 117: 656-662. N.A Estes, B Maron
Copyright ©2006 American Academy of Pediatrics
Weinstock, J. et al. Pediatrics 2006;117:e656-e662
Baseball and lacrosse chest protectors that were tested against chest blow-induced VF
Copyright ©2006 American Academy of Pediatrics
Weinstock, J. et al. Pediatrics 2006;117:e656-e662
Baseball chest protector design tested in this experiment
Survival with AED
When defibrillation is delivered within When defibrillation is delivered within one minute, the reported survival rate the reported survival rate can be as high as can be as high as 90%
For defibrillation within For defibrillation within five minutes, , the survival rate can be as high as the survival rate can be as high as 50%
Without defibrillation, survival is Without defibrillation, survival is less than 5%
After 12 minutes, the usual time it takes , the usual time it takes local EMS to arrive, it usually is local EMS to arrive, it usually is too late to revive the victimto revive the victim
NEJM 2000
Chance of survival
Ideal "Collapse-to-Shock" Goal for Early Defibrillation Programs Goal: < = 3 - 5 minutes
AED Reliability
96% of the time they are able to detect a rhythm that should be defibrillated
100% of the time they are able to recommend NOT shocking when the computer shows defibrillation Is not necessary
Window=5-6 minutes
Improvements in SurvivalImprovements in Survival
Registry data show that survival rates have increased:Registry data show that survival rates have increased:
Rising to 35% over the past decade, as compared with 15% Rising to 35% over the past decade, as compared with 15% forfor the preceding 10— betweenthe preceding 10— between 2006 and 2009 — the number 2006 and 2009 — the number of successful resuscitationsof successful resuscitations exceeded the number of deaths exceeded the number of deaths by 20%. by 20%.
Result of increased public awareness, the increased Result of increased public awareness, the increased availabilityavailability of automatic external defibrillators (AEDs), and of automatic external defibrillators (AEDs), and earlier activationearlier activation of the chain of survival (call to 911 and of the chain of survival (call to 911 and initiation of cardiopulmonaryinitiation of cardiopulmonary resuscitation, defibrillation, resuscitation, defibrillation, and advanced life-support measures).and advanced life-support measures).
Hey Coach: Do You Know Where The AED is?
Goals:
To Make Youth Baseball the safest organization it can be
Purchase AEDs for our fields
Incorporate AED training and awareness into orientation for allcoaches involved with YB
Provide SCA-AED simulation drills
Encourage simple screening for SCA risk
Emergency Plan
Establish an emergency action plan at all athletic venues.Establish an emergency action plan at all athletic venues.
Develop a communication system that includes local EMS phone Develop a communication system that includes local EMS phone numbers numbers
Simple training of all coaches on AED usage and SCASimple training of all coaches on AED usage and SCA
INSTALL AEDs in ALL high risk sports venuesINSTALL AEDs in ALL high risk sports venues
Location is Key!Location is Key! Make sure it readily is available and posted in high-visibility Make sure it readily is available and posted in high-visibility
areas.areas.
Players should receive a complete physical exam before Players should receive a complete physical exam before participating in sports activities and fill out a questionnerparticipating in sports activities and fill out a questionner
What else can be done?
Consider using chest protectors and safety ballsConsider using chest protectors and safety balls
Install AEDs in all sports venues Install AEDs in all sports venues
Provide access to all AEDs within 5 minutesProvide access to all AEDs within 5 minutes
Implement “chain of survival” – an immediate call to 911, Implement “chain of survival” – an immediate call to 911, early CPR, early defibrillation and immediate transport to early CPR, early defibrillation and immediate transport to hospital. hospital.
Provide education and training for all coachesProvide education and training for all coaches
Institute a refresher training every 2 years, (AHA)Institute a refresher training every 2 years, (AHA)
Local Children: Victims of SCA. No AED Local Children: Victims of SCA. No AED AvailableAvailable
Nader ParmanNader Parman
In May 2002, seven-year-old Nader was hit in the chest In May 2002, seven-year-old Nader was hit in the chest with a basketball between heartbeats, triggering with a basketball between heartbeats, triggering sudden cardiac arrest. The injury is called sudden cardiac arrest. The injury is called Commotio Commotio Cordis.Cordis. If an automated external defibrillator (AED) If an automated external defibrillator (AED) had been available, Nader’s life could have been had been available, Nader’s life could have been saved.saved.
SCA VictimSCA Victim
Greg Moyer: Notre Dame High School--NO AEDGreg Moyer: Notre Dame High School--NO AED
Greg played 10 minutes in a basketball game on December 2, 2000, when he Greg played 10 minutes in a basketball game on December 2, 2000, when he walked into the locker room and went into sudden cardiac arrest. No AED was walked into the locker room and went into sudden cardiac arrest. No AED was available, and CPR was not started for more than 10 minutes. Paramedics did available, and CPR was not started for more than 10 minutes. Paramedics did not arrive for 30 minutes, at which time his heart began to beat after being not arrive for 30 minutes, at which time his heart began to beat after being shocked with an AED. He was unable to sustain his heartbeat and died. shocked with an AED. He was unable to sustain his heartbeat and died.
SCA VictimSCA Victim
Louis Savino: Louis Savino: Cousin attended St. Andrew-NewtownCousin attended St. Andrew-Newtown
Died on Maccles Field-Yardley-off River RoadDied on Maccles Field-Yardley-off River Road
Louis, age 15, died on October 12, 2000, during soccer practice. Cause of death was Louis, age 15, died on October 12, 2000, during soccer practice. Cause of death was undetected Hypertrophic Cardiomyopathy (HCM).undetected Hypertrophic Cardiomyopathy (HCM).
SCA VictimSCA Victim
Louis AcomporaLouis Acompora
Louis died at age 14, March 25, 2000, during a Louis died at age 14, March 25, 2000, during a lacrosse game. In his position as goalie, Louis lacrosse game. In his position as goalie, Louis blocked what appeared to be a routine shot with his blocked what appeared to be a routine shot with his chest protector, took a few steps and collapsed. chest protector, took a few steps and collapsed. Paramedics arrived with a defibrillator almost 15 Paramedics arrived with a defibrillator almost 15 minutes later. Louis died from minutes later. Louis died from Commotio CordisCommotio Cordis, ,
Victim of SCAVictim of SCA
Nick OverNick OverOn the morning of April 8, 2001, Nick was found unconscious On the morning of April 8, 2001, Nick was found unconscious in his bed. His parents found him and immediately dialed 911. He was worked in his bed. His parents found him and immediately dialed 911. He was worked on at home and in the hospital, but could not be revived. Cause of the fatal on at home and in the hospital, but could not be revived. Cause of the fatal sudden cardiac arrest was found to be Arrhythmogenic Right Ventricular sudden cardiac arrest was found to be Arrhythmogenic Right Ventricular Dysplasia (ARVD)Dysplasia (ARVD)
Recent DeathRecent Death
May 20, 2010
Autopsy confirmed he died of heart contusion
Survivor-Passed OutSurvivor-Passed Out
Daniel Fucich: Holy Ghost Prep-August 2009
Shocking rescue from clutches of death Shocking rescue from clutches of death
Shocking rescue from clutches of deathBucks County Courier Times-March 2010
John Cochrane, the coach of his 13-year-old grandson Hunter's youth basketball team, suffered a heat attack March 7 in the last two minutes of a Warminster Basketball Association game at William Tennent High School. Warminster Fire Chief Mitch Shapiro, whose son was playing in the game, and two parents who are nurses, rushed onto the court and used an automated external defibrillator to revive Cochrane
George School CoachGeorge School Coach
May 2010May 2010
SCA-life was saved by an AEDSCA-life was saved by an AED
Heart bypass 2 days laterHeart bypass 2 days later
Holland ParentHolland Parent
This May, 2010 a Holland, PA father was pitching to This May, 2010 a Holland, PA father was pitching to his son in the batting cages and suffered SCA.his son in the batting cages and suffered SCA.
He died in front of the Holland LL president and 2 He died in front of the Holland LL president and 2 entire baseball teams, including his sonentire baseball teams, including his son
No AED was availableNo AED was available
EMS arrived but was unable to reviveEMS arrived but was unable to revive
Lessons learned about EMS activation-Lessons learned about EMS activation-give specific give specific directions, stay on phone, send flaggers to streetdirections, stay on phone, send flaggers to street
Survivors-AEDSurvivors-AED
16-year-old Zach suffered cardiac arrest during class in October, 2009. The 16-year-old Zach suffered cardiac arrest during class in October, 2009. The availability of an AED and the actions of the school nurse saved his life., availability of an AED and the actions of the school nurse saved his life., Zach has returned to school and opened a savings account to collect Zach has returned to school and opened a savings account to collect donations to provide AEDs, training and education to local non-profit donations to provide AEDs, training and education to local non-profit organizations. He is expected to make a full recovery.organizations. He is expected to make a full recovery.
Survivor-AEDSurvivor-AED
Matt KeeneMatt Keene--
On October 18, 2006, as a routine football practice , Matt collapsed on On October 18, 2006, as a routine football practice , Matt collapsed on the field after suffering sudden cardiac arrest (SCA). His heart had the field after suffering sudden cardiac arrest (SCA). His heart had stopped, and he had no pulse. Thanks to the quick response of those stopped, and he had no pulse. Thanks to the quick response of those at the scene, use of AED, Matt survived. at the scene, use of AED, Matt survived.
Survivor-AEDSurvivor-AED
Matt NaderMatt NaderMatt collapsed during a football game. Matt collapsed during a football game. His mother performed CPR as he laid on the track, His mother performed CPR as he laid on the track, but the use of an automated external defibrillator but the use of an automated external defibrillator saved his life. saved his life. --
Survivor-AEDSurvivor-AED
Teddy OkerstromTeddy Okerstrom
16-year-old Teddy collapsed on June 16, 2009, while 16-year-old Teddy collapsed on June 16, 2009, while participating in a summer football conditioning program. One participating in a summer football conditioning program. One of his coaches dispatched others to call 911 and retrieve the of his coaches dispatched others to call 911 and retrieve the AED, while he immediately started CPR. The AED was rushed AED, while he immediately started CPR. The AED was rushed to the field, where coaches and others continued CPR until the to the field, where coaches and others continued CPR until the ambulance arrived.ambulance arrived.
