Posted on 11/05/2013

Dr. Jonathan DreznerIt’s every parent’s and coach’s worst nightmare: A young athlete suddenly collapses and lies unresponsive on the playing field.

Assume it’s sudden cardiac arrest until you know otherwise, said Dr. Jonathan Drezner, professor in the Department of Family Medicine at the University of Washington, a team physician for the Seattle Seahawks and a member of the USA Football Medical Advisory Committee.

Concussions tend to get the headlines, but sudden cardiac arrest is the No. 1 cause of death for youth and teen athletes during sports.

With proper preparation and training, Drezner said school and league administrators can greatly reduce tragic outcomes when an incident occurs.

What are the causes – biological and external factors – that can lead to sudden cardiac arrest?

Sudden cardiac arrest is the result of structural or electrical disorders in the heart.

Individuals can suffer from cardiomyopathy, a disease of the heart muscle. Included in that is hypertrophic cardiomyopathy, where the heart muscle becomes unnaturally thick, making it more prone to arrhythmias and harder to pump blood.

The heart also can be structurally normal but a problem exists in its electrical system.

One of the main challenges for parents and the medical community is that the majority of kids who suffer sudden cardiac arrest on the playing field have no warning symptoms or pre-knowledge of their heart disorder. The first sign is often collapse during exercise and the cardiac arrest itself. That makes it challenging to screen kids for heart disorders.

What can parents and leagues do to help prevent sudden cardiac arrest?

It is important to recognize that no screening program is perfect. Screening certainly can identify some individuals at risk, and because of that, it is recommended that young athletes see a doctor before participating in sports. However, it also is of paramount importance that adults supervising youth athletes during sports be prepared to respond to someone who collapses in sudden cardiac arrest.

At the high school and college levels, athletes are required to have a pre-participating sports physical. At the University of Washington, we don’t do a sports physical without an EKG – an additional tool that can help identify high risk athletes.

The challenge for more widespread EKG screening is understanding how to read the EKG. It becomes a specialty and experience-driven procedure, and we do not have physicians trained in every community, which makes it difficult to establish standards and guidelines.

Why is it important to have a defibrillator available at all athletic events?

Putting a defibrillator (AED) in schools and youth sports settings is really a public safety measure. You may use it to save a child’s life, but half the time you use the devices on an adult – a coach, a teacher, a spectator.

Within college and professional sports, there are AEDs available along with medical professionals and/or coaches who are trained in CPR, how to use an AED and how to recognize sudden cardiac arrest. In high school sports, many schools don’t have defibrillators at fields, and coaches may not be trained in CPR. At youth sporting venues, it is very unlikely that one is available.

Parents, schools, USA Football and the medical community can work together so there is proper training and equipment to respond to sudden cardiac arrest. When AEDs become more accessible, it becomes safer for everyone. Eventually, defibrillators should be like fire extinguishers. We only use them in emergencies, but we know there is one close by if we need it.

How can coaches and parents tell the difference between sudden cardiac arrest and a player collapsing because of exhaustion or other causes?

Any child who collapses and is unresponsive on the playing field should be assumed to be in cardiac arrest until proven otherwise.

An athlete passing out during exercise is not normal, especially in the middle of exercise or a game. Some athletes may have warning symptoms of a heart condition, such as chest pain, a racing heart when it shouldn’t or prior episodes of passing out. There could be fatigue or shortness of breath that is new and disproportionate to the level of exertion. A child who normally has no problem keeping up with his or her peers could suddenly be struggling.

Even if that child doesn’t collapse or suffer sudden cardiac arrest, he or she should see their physician for evaluation.

A challenge to responding to sudden cardiac arrest is quickly recognizing the emergency. If an athlete collapses while running and is unconscious without any recent trauma, you have to assume cardiac arrest.

About 50 percent of young athletes with sudden cardiac arrest will have brief seizure-like activity, with arm or leg jerking movements. People think it’s just a seizure, but it’s not.

What should coaches and parents should do if they suspect sudden cardiac arrest?

Call 911.

Then as soon as possible, begin hands only CPR with chest compressions and have someone close-by get the defibrillator if there is one available. AEDs are safe and easy to use and provide voice and visual instructions so anyone can use them effectively.

If you do these things, you have a good chance to saving someone who is in a life-threatening situation.

SOURCE: Joe Frollo, USA Football