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  • Slide 1
  • What is Sudden Cardiac Arrest? Sudden cardiac arrest is the leading cause of death among young athletes Sudden cardiac arrest is the leading cause of death among young athletes Athletes are considered the healthiest members of society, yet catastrophic death can occur without warning signs. Athletes are considered the healthiest members of society, yet 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 die After a few minutes of VF the vital organs do not get blood flow and will die The heart must receive a shock from an AED to reset the electrical system The heart must receive a shock from an AED to reset the electrical system An AED and CPR can quadruple survival from SCA An AED and CPR can quadruple survival from SCA Community AED programs are the only way to insure immediate access to life saving therapies Community AED programs are the only way to insure immediate access to life saving therapies
  • Slide 2
  • The survival rate of an individual declines approximately 10% for every minute that passes 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 Sudden Cardiac 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 Counts! Occurs most commonly in baseball and lacrosse
  • Slide 3
  • Why do this? Dont always have doctors and nurses on the fields during games Dont always have doctors and nurses on the fields during games Dont know where lightening will strike Dont know where lightening will strike SCA is not so rare SCA is not so rare SCA can happen secondary to other injuries SCA can happen secondary to other injuries AEDs are easy to use; dont make mistakes AEDs are easy to use; dont make mistakes Anyone can help save a life Anyone can help save a life
  • Slide 4
  • Incidence The precise incidence of commotio cordis in children is because of the absence of systematic and mandatory reporting, but based upon data from the in Minneapolis > 224 deaths-last 12 yrs The precise incidence of commotio cordis in children is unknown because of the absence of systematic and mandatory reporting, but based upon data from the National Commotio Cordis Registry in Minneapolis > 224 deaths-last 12 yrs It is among the most frequent cardiovascular causes of sudden death in young athletes, after hypertrophic cardiomyopathy and congenital coronary-artery anomalies It is among the most frequent cardiovascular causes of sudden death in young athletes, after hypertrophic cardiomyopathy and congenital coronary-artery anomalies
  • Slide 5
  • Look at your own safety Would you cancel your home owners insurance since you had no claims in 10 yrs? Would you cancel your home owners insurance since you had no claims in 10 yrs? Would you cancel your health insurance since you have been healthy for 10 yrs? Would you cancel your health insurance since you have been healthy for 10 yrs? Would you allow your childrens schools to remove fire extinguishers since they had no fires in 10 yrs? Would you allow your childrens schools to remove fire 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 trained to do something simple? Would you let someone die because you were not informed or trained to do something simple?
  • Slide 6
  • Who is at Risk? About 50% of commotio cordis events have been reported in young competitive athletes (mostly those between 11 and 20 years of age) About 50% of commotio cordis events have been reported in young competitive athletes (mostly those between 11 and 20 years of age) Typically baseball, softball, ice hockey, football, or lacrosse Typically baseball, softball, ice hockey, football, or lacrosse In baseball, for example, commotio cordis is often triggered when players are struck in the chest by balls that have been pitched, batted, or thrown in a variety of scenarios In baseball, for example, commotio cordis is often triggered when players are struck in the chest by balls that have been pitched, batted, or thrown in a variety of scenarios
  • Slide 7
  • Maron B and Estes N. N Engl J Med 2010;362:917-927 Distribution of Commotio Cordis Events According to Age and Activity
  • Slide 8
  • Maron B and Estes N. N Engl J Med 2010;362:917-927 Mechanism of Commotio Cordis
  • Slide 9
  • Maron B and Estes N. N Engl J Med 2010;362:917-927 Examples of Circumstances in Which Chest Blows Have Triggered Commotio Cor dis
  • Slide 10
  • Is it Instantaneous? Although cardiovascular collapse is virtually instantaneous, 20% of victims remain physically active for a few seconds after the blow (e.g., continuing to walk, run, skate, throw a ball, or even speak), which may reflect individual tolerance for sustained ventricular tachyarrhythmia. Although cardiovascular collapse is virtually instantaneous, 20% of victims remain physically active for a few seconds after the blow (e.g., continuing to walk, run, skate, throw a ball, or even speak), which may reflect individual tolerance for sustained ventricular tachyarrhythmia. (For example, a baseball pitcher struck in the chest by a batted ball was able to retrieve the ball at his feet, successfully complete the play (throwing out the base runner), and then prepare for his next pitch before collapsing. (For example, a baseball pitcher struck in the chest by a batted ball was able to retrieve the ball at his feet, successfully complete the play (throwing out the base runner), and then prepare for his next pitch before collapsing. In another instance, a batter was struck by a pitch while attempting to bunt and collapsed only after running to first base.) In another instance, a batter was struck by a pitch while attempting to bunt and collapsed only after running to first base.)
  • Slide 11
  • 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?
  • Slide 12
  • 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
  • Slide 13
  • 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
  • Slide 14
  • Copyright 2006 American Academy of Pediatrics Weinstock, J. et al. Pediatrics 2006;117:e656-e662 Baseball chest protector design tested in this experiment
  • Slide 15
  • Survival with AED When defibrillation is delivered within the reported survival rate can be as high as When defibrillation is delivered within one minute, the reported survival rate can be as high as 90% For defibrillation within, the survival rate can be as high as For defibrillation within five minutes, the survival rate can be as high as 50% Without defibrillation, survival is Without defibrillation, survival is less than 5%, the usual time it takes local EMS to arrive, it usually is to revive the victim After 12 minutes, the usual time it takes local EMS to arrive, it usually is too late to revive the victim NEJM 2000 Chance of survival Ideal "Collapse-to-Shock" Goal for Early Defibrillation Programs Goal: < = 3 - 5 minutes
  • Slide 16
  • 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
  • Slide 17
  • Improvements 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% for the preceding 10 between 2006 and 2009 the number of successful resuscitations exceeded the number of deaths by 20%. Rising to 35% over the past decade, as compared with 15% for the preceding 10 between 2006 and 2009 the number of successful resuscitations exceeded the number of deaths by 20%. Result of increased public awareness, the increased availability of automatic external defibrillators (AEDs), and earlier activation of the chain of survival (call to 911 and initiation of cardiopulmonary resuscitation, defibrillation, and advanced life-support measures). Result of increased public awareness, the increased availability of automatic external defibrillators (AEDs), and earlier activation of the chain of survival (call to 911 and initiation of cardiopulmonary resuscitation, defibrillation, and advanced life-support measures).
  • Slide 18
  • 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 all coaches involved with YB Provide SCA-AED simulation drills Encourage simple screening for SCA risk
  • Slide 19
  • 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 numbers Develop a communication system that includes local EMS phone numbers Simple training of all coaches on AED usage and SCA Simple training of all coaches on AED usage and SCA INSTALL AEDs in ALL high risk sports venues INSTALL AEDs in ALL high risk sports venues Location is Key! Location is Key! Make sure it readily is available and posted in high-visibility areas. Make sure it readily is available and posted in high-visibility areas. Players should receive a complete physical exam before participating in sports activities and fill out a questionner Players should receive a complete physical exam before participating in sports activities and fill out a questionner
  • Slide 20
  • What else can be done? Consider using chest protectors and safety balls Consider 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 minutes Provide access to all AEDs within 5 minutes Implement chain of survival an immediate call to 911, early CPR, early defibrillation and immediate transport to hospital. Implement chain of survival an immediate call to 911, early CPR, early defibrillation and immediate transport to hospital. Provide education and training for all coaches Provide education and training for all coaches Institute a refresher training every 2 years, (AHA) Institute a refresher training every 2 years, (AHA)
  • Slide 21
  • Slide 22
  • Local Children: Victims of SCA. No AED Available Nader Parman In May 2002, seven-year-old Nader was hit in the chest with a basketball between heartbeats, triggering sudden cardiac arrest. The injury is called Commotio Cordis. If an automated external defibrillator (AED) had been available, Naders life could have been saved. In May 2002, seven-year-old Nader was hit in the chest with a basketball between heartbeats, triggering sudden cardiac arrest. The injury is called Commotio Cordis. If an automated external defibrillator (AED) had been available, Naders life could have been saved.
  • Slide 23
  • SCA Victim Greg Moyer: Notre Dame High School--NO AED 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 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 shocked with an AED. He was unable to sustain his heartbeat and died. 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 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 shocked with an AED. He was unable to sustain his heartbeat and died.
  • Slide 24
  • SCA Victim Louis Savino: Cousin attended St. Andrew-Newtown Louis Savino: Cousin attended St. Andrew-Newtown Died on Maccles Field-Yardley-off River Road Died on Maccles Field-Yardley-off River Road Louis, age 15, died on October 12, 2000, during soccer practice. Cause of death was undetected Hypertrophic Cardiomyopathy (HCM). Louis, age 15, died on October 12, 2000, during soccer practice. Cause of death was undetected Hypertrophic Cardiomyopathy (HCM).
  • Slide 25
  • SCA Victim Louis Acompora Louis died at age 14, March 25, 2000, during a lacrosse game. In his position as goalie, Louis blocked what appeared to be a routine shot with his chest protector, took a few steps and collapsed. Paramedics arrived with a defibrillator almost 15 minutes later. Louis died from Commotio Cordis, Louis died at age 14, March 25, 2000, during a lacrosse game. In his position as goalie, Louis blocked what appeared to be a routine shot with his chest protector, took a few steps and collapsed. Paramedics arrived with a defibrillator almost 15 minutes later. Louis died from Commotio Cordis,
  • Slide 26
  • Victim of SCA Nick Over 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 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 Dysplasia (ARVD) Nick Over 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 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 Dysplasia (ARVD)
  • Slide 27
  • Recent Death May 20, 2010 Autopsy confirmed he died of heart contusion
  • Slide 28
  • Survivor-Passed Out Daniel Fucich: Holy Ghost Prep-August 2009
  • Slide 29
  • Shocking rescue from clutches of death Bucks 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
  • Slide 30
  • George School Coach May 2010 May 2010 SCA-life was saved by an AED SCA-life was saved by an AED Heart bypass 2 days later Heart bypass 2 days later
  • Slide 31
  • Holland Parent This May, 2010 a Holland, PA father was pitching to his son in the batting cages and suffered SCA. This May, 2010 a Holland, PA father was pitching to his son in the batting cages and suffered SCA. He died in front of the Holland LL president and 2 entire baseball teams, including his son He died in front of the Holland LL president and 2 entire baseball teams, including his son No AED was available No AED was available EMS arrived but was unable to revive EMS arrived but was unable to revive Lessons learned about EMS activation- give specific directions, stay on phone, send flaggers to street Lessons learned about EMS activation- give specific directions, stay on phone, send flaggers to street
  • Slide 32
  • Survivors-AED 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., Zach has returned to school and opened a savings account to collect donations to provide AEDs, training and education to local non-profit organizations. He is expected to make a full recovery. 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., Zach has returned to school and opened a savings account to collect donations to provide AEDs, training and education to local non-profit organizations. He is expected to make a full recovery.
  • Slide 33
  • Survivor-AED Matt Keene - Matt Keene -
  • Slide 34
  • Survivor-AED Matt Nader Matt collapsed during a football game. His mother performed CPR as he laid on the track, but the use of an automated external defibrillator saved his life. - Matt Nader Matt collapsed during a football game. His mother performed CPR as he laid on the track, but the use of an automated external defibrillator saved his life. -
  • Slide 35
  • Survivor-AED Teddy Okerstrom Teddy Okerstrom
  • Slide 36
  • Slide 37