Alexei Cherepanov of KHL Omsk Avangard died suddenly during a game in 2008 at the age of nineteen.
A sadly familiar scene played out this week near Ottawa when 15-year-old Tyler Kerr collapsed during a hockey game and later died. He had just returned to the bench after a shift when he lost consciousness, and was quickly tended to by coaches and volunteer firefighters. They did CPR, used an AED (automated external defibrillator) to deliver shocks, and he was taken by ambulance to a local hospital. He lived long enough to be transferred to CHEO (the Children’s Hospital of Eastern Ontario), but died some eight hours after his collapse. In this case everything went right, but the outcome was still wrong. For every sudden cardiac arrest that’s properly handled, how many more aren’t handled at all?
When’s the last time you took a CPR class? Never? Why not? No, no – don’t answer that. Your excuses are invalid. Survival rates from out-of-hospital cardiac arrest are minimal – anywhere from a dismal 2% to a slightly less dismal 10% of patients will survive. EMS providers will tell you that “saves” are rare, and those that happen generally have early CPR and defibrillation in common. With CPR classes readily available and AEDs in almost every public location you can imagine, there’s no reason why a sudden cardiac arrest patient shouldn’t have every opportunity to walk out of the hospital, and why you shouldn’t be the one to step up and help that happen.
What is it?
Sudden cardiac arrest (SCA) is exactly what it sounds like – the heart stops suddenly, usually with no warning symptoms. It’s the leading cause of death in athletes under 25, and it has touched amateur and professional sports again and again. SCA is not a heart attack. A heart attack (or more properly a myocardial infarction) happens when a coronary artery becomes blocked by your poor diet and lifestyle choices, and a portion of heart muscle dies. By contrast, SCA is most often due to a structural heart problem that the victim may not have even known they had. The heart stops beating in a normal, organized manner and develops a dysrhythmia (irregular rhythm). A dysrhythmic heart can’t pump blood around the body, oxygen doesn’t go where it needs to go, and the victim dies.
Why does this happen?
There are several causes for SCA, but by far the most common in young adults in hypertrophic cardiomyopathy (HCM). HCM is a genetic disorder in which the heart muscle thickens and muscle fibers aren’t arranged in the normal orderly fashion. HCM may or may not also involve an obstruction of the heart’s outflow tract – meaning blood may be impeded on its trip out of the heart to carry oxygen to the rest of the body. Many people with HCM may never know they have it – there may be a vague family history of fainting or exercise intolerance, or nothing at all. The thickened heart muscle pumps less efficiently, and can lead to eventual heart failure. The other problem with HCM is the possibility of dysrhythmia – that’s that whole thing where your heart stops pumping blood and just sits there beating erratically.
HCM is diagnosed by a thorough history and physical exam, an EKG, and an echocardiogram (an ultrasound of the heart that can detect the thickened muscle and outflow obstruction). This is one of the main things docs are looking for when they do a sports physical. The problem is there are several sets of guidelines for sports physicals, and nobody seems to be able to agree which ones to use. The American Heart Association puts heavy emphasis on history taking and physical exam, and actually recommends against routine use of EKG or echo as a screening tool. The NFL, MLB, NBA and NHL all screen their athletes annually, with the NBA being considerably ahead of the game – they require an annual echo and EKG on every player.
How do you treat it?
If you know you have HCM, you stop participating in sports. You take medications to reduce the workload on your heart, and you may need an AICD (automated implantable cardioverter-defibrillator) – an internal defibrillator that detects dysrhythmias and administers a shock to reset the heart’s electrical system.
Nerd moment: Defibrillation (shocking someone) doesn’t jump-start the heart. It interrupts the messed up electrical impulses that are causing the dysrhythmia, effectively resetting the heart so its own internal pacemaker can take back over. Yes, your heart has its own built-in natural pacemaker.
If you don’t know you have HCM and you collapse, you need CPR to keep the blood and oxygen going to (most importantly) your brain, and you need a shock to get your heart back on track. Studies have shown that bystanders using an AED to deliver shocks can increase survival rates of SCA victims to 15 to 30%. Survival rates when nobody does CPR or uses an AED? Zero. Obviously there’s no guarantee that every SCA victim can be saved, but if increase in survival with bystander CPR and AED use don’t convince you that you need to go take a class, then there’s something basically wrong with you.
Okay, so I want to take CPR.
Are you in the US? The American Red Cross and American Heart Association offer CPR classes all the time. For around $100 you can learn adult and child CPR, and how to use an AED, and the certification is good for two years. You can even take a hybrid classroom/online course (there go your “I don’t have time” excuses). You can have them put on a class for your co-workers, hockey team, or friends. In fact, if you’re a hockey coach, why haven’t you had your team take a class yet? Don’t want to come off the cash for a class? Google it. Lots of communities offer completely free CPR training. There go your “that’s too expensive” excuses.
Are you in Canada? St. John Ambulance offers CPR courses. So does the Canadian Red Cross. There’s the same range of costs you’ll find in the US – slightly more expensive options in the $100 range, and some completely free courses. The Ottawa Paramedic Service puts on free introductory CPR/AED courses from time to time. Did I mention that you can google it? You can. Google it. Go find yourself a free course and quit making excuses.
Stop making excuses. Take CPR. Save a life.