Sudden cardiac arrest (SCA) occurs when the heart suddenly and unexpectedly stops beating. Unlike a heart attack, which occurs from a blockage that limits blood flow to a part of the heart, SCA occurs when the heart loses function, causing breathing to stop and the individual to become unconscious.
SCA can occur in anyone at any age–youth included. According to the Centers for Disease Control and Prevention (CDC), about 2,000 young people under the age of 25 die of SCA each year. By being aware of symptoms and knowing how to respond, one could save a life in an emergent situation.
Knowing the signs of SCA is especially crucial when it comes to young athletes. 60 million children between the ages of six and 18 participate in organized sports each year, as stated by the National Council of Youth Sports. In addition to knowing the signs, knowing how to be proactive regarding SCA can be critical.
We met with multiple health care professionals within the UAB Heersink School of Medicine and UAB Medicine to learn more about SCA, its indicators, and actions to take, as well as some educational and life-saving resources that are available.
The following information was collectively provided by Irfan M. Asif, M.D., professor and chair of the UAB Department of Family and Community Medicine; Sara Gould, M.D., MPH, associate professor in the UAB Department of Orthopaedic Surgery; Camden Hebson, M.D., associate professor in the UAB Department of Pediatrics; Austin Kane, M.D., assistant professor in the UAB Department of Pediatrics, and James Jones, head athletic trainer for the UAB Heersink School of Medicine.
What are the signs/symptoms of sudden cardiac arrest?
The typical signs of a cardiac arrest include abrupt loss of consciousness with eyes rolled back, seizure-like activity due to lack of oxygen flow to the brain, and irregular, labored, or no breathing. Additionally, someone suffering from SCA may have a very weak pulse or no palpable pulse at all.
What can cause sudden cardiac arrest in youths? How often does this occur?
The most common causes of SCA in young people end up being hypertrophic cardiomyopathy or its variant, coronary artery anomalies, and autopsy negative–meaning an autopsy revealed no cause of death. When an autopsy reveals no findings, it can sometimes be presumed that an arrhythmia was present. As mentioned above, the CDC reports around 2,000 young people under 25 die each year due to SCA.
What should you do if you notice someone experiencing signs or symptoms of a sudden cardiac arrest (SCA)?
If someone has a cardiac arrest, you should first assess the person, checking for a pulse and responsiveness. If no pulse is found, the next steps are summed up in the phrase “Call-Push-Shock” (modeled after Stop, Drop, Roll). You should call 9-1-1, start CPR, and get the nearest automated external defibrillator (AED), turn it on, and follow the prompts. When it comes to sports, the goal is to place an AED on an athlete and defibrillate within three to five minutes.
Why is it important to be aware of the signs, symptoms, and risk of sudden cardiac arrest, specifically when it comes to youth?
Cardiac arrest carries a very high mortality–meaning many people don't survive. However, with emergency action plans (EAPs), appropriate equipment (AEDs), and the right training, we can improve the odds of survival. We are seeing people walk out of the hospital after sudden cardiac arrest, where we didn't necessarily see that in the past. This is due in large part to having the right equipment available and the proper training to use it.
How can you be proactive?
Know the signs/symptoms of SCA.
Know CPR.
Know where AEDs are located and how to use them.
Have an emergency action plan.
Sports/Athletics
When it comes to sports, it is recommended that all athletes have a yearly physical with their physician as part of a pre-participation examination. During the visit, the physician should ask the athlete about his or her medical history and if there are any concerns. The physician may then order additional tests. Family history is key to know, particularly if someone had a first-degree relative with a heart problem before the age of 35.
Some experts with the right expertise and infrastructure may conduct an electrocardiogram (ECG) as part of the screening process. Regardless of the screening modality that is chosen, no screening program is perfect, so an EAP is needed at every venue and should be rehearsed yearly. At that time, it is important to make sure that the AED is accessible, the battery works, and that people feel comfortable with its use.
Given that sudden cardiac arrest is not a common occurrence but can have devastating outcomes, it is important for people to be ready to act if something were to happen – specifically in environments with increased risk, including sporting events or practices. Coaches, especially, should be aware of the signs of sudden cardiac arrest, trained in CPR and AED use, know the location of the nearest AED, be familiar with the field/court cardiac EAP, and ideally perform a medical timeout before the event to share this information with people unfamiliar with the facility. Additionally, having an athletic trainer present at all sporting events is key to ensuring athletes’ safety in any emergency medical situation.
Individuals/Families
For individuals and families, if there is a family history of sudden cardiac arrest, sudden death, or unexplained/unexpected death before middle age, you should talk with your primary care physician. It would be important to learn CPR, learn how to identify AEDs, and realize that anyone can use an AED, not just emergency medical personnel.
Organizations
It is very important for organizations to prepare for potential sudden cardiac arrest. This includes having the appropriate number of AEDs available on-site, an awareness of the signs of cardiac arrest, staff trained in CPR and AED use, a formal cardiac EAP shared with everyone in the organization, and ideally running periodic AED drills.
What are some resources available to parents, coaches, and/or the public?
Local resources:
UAB Sports Medicine Cardiology Clinic for Young Athletes
The UAB Sports Medicine Cardiology Clinic is a highly specialized clinic focusing on young athletes who need cardiac care along with sports medicine treatment–including patients affected by COVID-19. Cardiac care services at UAB Medicine are part of our nationally ranked Cardiovascular Institute, which offers the full range of care for the heart.
Located at UAB Hospital-Highlands, the clinic is a partnership between the UAB Department of Orthopaedic Surgery and the Department of Family and Community Medicine, with Dr. Sara Gould from the Department of Orthopaedic Surgery and Dr. Camden Hebson from the Department of Pediatrics leading the clinic efforts.
CPR-certification for coaches
Locally, Birmingham City School coaches, teachers, and school personnel, are provided CPR instruction through a joint effort of UAB Sports & Exercise Medicine and Birmingham City Schools. This type of support and training is also available to other school systems. James Jones, head athletic trainer for the UAB Heersink School of Medicine and Birmingham City Schools through UAB Sports & Exercise Medicine, serves as one of the American Heart Association instructors through the Birmingham Regional Emergency Medical Services System in partnership with Dr. Sherri Huff, with Birmingham City Schools. Dr. Huff has been instrumental in making sure coaches and physical education instructors with Birmingham City Schools are certified.
CoachSafely Foundation
The CoachSafely Foundation offers education to parents and resources on the safety of youth athletes, including awareness and information on sudden cardiac arrest. The foundation aims to “limit youth sports-related injuries through research, advocacy and education of coaches, parents, physical educators, and other influential figures in young athletes’ lives.”
Drew Ferguson, director of Sports Medicine at UAB, serves as CEO of the CoachSafely Foundation, and Dr. Irfan Asif, professor and chair of the UAB Department of Family and Community Medicine, serves on the CoachSafely Foundation Advisory board.
Outside resources and information:
American Heart Association
SADS Foundation
Project Adam
Citizen CPR Foundation
Parent Heart Watch
ORCCA