Heart disease is the leading cause of death in the United States, having eclipsed cancer-related deaths, and sudden cardiac death is the most common immediate cause of death amongst heart disease–related deaths. According to the American Heart Association, during one year of study the incidence of Emergency Medical Services-assessed out-of-hospital sudden cardiac arrest in the US was 326,200 with an average survival rate of 10.6%.1
Unfortunately, the young are not excluded from this risk. Several studies conducted over the last several decades have demonstrated risk of sudden cardiac death in the young somewhere between 1 to as high as 8.3 deaths per 100,000 young per year.2-5 Although sudden cardiac arrest in student athletes may be more visible, sudden cardiac death also occurs in young nonathletes.4,6
Because approximately 20 percent of a community is in its schools on any given day, including students, teachers, staff and family members, a focused effort on cardiac arrest preparedness in schools is critical to protecting our children and others in the community and beyond.
Cardiac arrest preparedness in the schools should include:
Cardiopulmonary Resuscitation (CPR) training for school staff, teachers, coaches, and students.
Cardiac Emergency Response Plans (CERPs) to ensure that all staff are able to respond quickly and decisively to a cardiac arrest on the school grounds.
Automated External Defibrillators (AEDs) to provide rapid defibrillation in the event of sudden cardiac arrest caused by ventricular fibrillation, with ongoing maintenance plans and drills.
Drills to enhance staff familiarity, rapid on-site communication and practiced coordination with local Emergency Medical Services.
Emergency Action Plans (EAPs) for individual students known to be at risk.
1American Heart Association Heart Disease and Stroke Statistics 2015 Update.
2Sudden unexpected death in children and adolescents. Driscoll DJ, Edwards W; JACC 1985.
3Sudden cardiac death in infants, children, and adolescents. Berger S, Dhala A, Friedberg D; Pediatric Clinics of North America 1999.
4Incidence of sudden cardiac arrest in high school student athletes on school campus. Toresdahl B, Rao A, Harmon K, Drezner J; Heart Rhythm 2014.
5Prospective study of sudden cardiac death among children and young adults. Bagnall RD, et.al.; NEJM 2016.
6Risk Factors of Sudden Cardiac Death in the Young: A Multiple-Year Community-Wide Assessment
Reshmy Jayaraman, Kyndaron Reinier, Sandeep Nair, Aapo L. Aro, Audrey Uy-Evanado, Carmen Rusinaru, Eric C. Stecker, Karen Gunson, Jonathan Jui, Sumeet S. Chugh
Sudden Cardiac Arrest (SCA)
Sudden cardiac arrest occurs when the heart stops beating, leading to loss of circulation and loss of consciousness, with no blood flow to the brain and other vital organs. Without immediate life support measures, SCA results in rapid death (Sudden Cardiac Death, or SCD).
There are multiple causes of SCA. The result is a terminal heart rhythm called ventricular fibrillation, which is when the heart cannot pump efficiently due to chaotic electrical activity. However, when treated rapidly with CPR and defibrillation with an automated external defibrillator (AED), normal heart rhythm can often be restored. Cardiac arrest preparedness can save the life of someone suffering a SCA during those critical first few minutes. Every minute counts! Study after study has demonstrated that the best chance of saving a life is within the first 4 minutes of a SCA. Survival to hospital discharge for SCA in children ages 1 to 12 is 14.4%, and in children ages 13 to 18 it is 19.9%.1 Every passing minute reduces the chance of survival by 7-10%.2 Therefore, reducing time to defibrillation will improve survival by 7-10% per minute. Early and effective CPR has been demonstrated to double or triple the chance of SCA survival.3
Prior Warning Signs
Often there is no prior warning sign that identifies a person at risk of SCA. Possible warning signs, when present, can include:
Fainting or dizziness with exercise
Excessive fatigue or shortness of breath with exercise
Chest pain or chest discomfort with exercise
Similarly, there may be no known risk factor that identifies a person at risk of SCA. Risk factors for SCA, when present, can include:
Diseases causing abnormal heart structure, for example Congenital Heart Disease and various forms of Cardiomyopathy.
Electrical diseases of the heart, which can predispose to abnormal heart rhythms like ventricular fibrillation. These include Wolff-Parkinson-White Syndrome and Long QT Syndrome.
Coronary Artery Disease, most commonly caused by atherosclerosis. (Risk factors for atherosclerosis include obesity, high blood pressure, sedentary lifestyle, tobacco use, diabetes and a family history of coronary artery disease).
Exposure to certain drugs of abuse such as cocaine, inhalants, recreational or club drugs, and even some prescription medications.
Family history of sudden unexplained or sudden cardiac death in a close relative before age 50.
Sudden blow to the chest directly over the heart (called commotio cordis).
1 CARES 2016 data.
2 Larsen, M., Eisenberg, M., Cummins, R., & Hallstrom, A. (1993). Predicting survival from out-of-hospital cardiac arrest: A graphic model. Annals of Emergency Medicine., 22(11), 1652-1658.
3 American Heart Association (https://cpr.heart.org/AHAECC/CPRAndECC/AboutCPRFirstAid/CPRFactsAndStats/UCM_475748_CPR-Facts-and-Stats.jsp).
Automated External Defibrillator (AED)
An Automated External Defibrillator (AED) is a portable electronic device which, when properly applied, automatically diagnoses potentially life-threatening heart rhythms including SCA. Modern AEDs are designed to be used by any motivated bystander, regardless of training. The devices advise the user about how to apply the device and whether or not to administer a shock. Some devices shock automatically if the victim has a fatal heart rhythm. Training is important, however, particularly since almost all victims also need Cardiopulmonary Resuscitation (CPR) to keep the blood circulating while the AED is being mobilized and to help establish a good heart beat after the AED is used. Most of the time, the AED will advise the user to administer CPR, depending on the needs of the victim, and in these cases it is quite helpful to have CPR training. AEDs have been used successfully by police, firefighters, flight attendants, security guards and lay people.
Survival rates decrease by 10% with each minute of delayed defibrillation. The five links within the Cardiac Chain of Survival are designed to minimize the time between arrest and defibrillation and increase survival.
Chain of Surval Links:
Early recognition of Sudden Cardiac Arrest (SCA)
Collapsed and unresponsive
Gasping, gurgling, snorting, moaning or labored breathing
Early Access to 911
- Begin cardiopulmonary resuscitation (CPR) immediately
- Immediately retrieve and use an AED as soon as possible to restore the heart to its normal rhythm
Early Advanced Care
- Emergency Medical Services (EMS) responders begin advanced life support and transfer to a hospital
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