Sudden cardiac arrest in intercollegiate athletes: Detailed analysis and outcomes of resuscitation in nine cases

Abstract

Public access defibrillation programs have demonstrated a survival benefit in persons with out-of-hospital cardiac arrest. However, little is known about the effectiveness of early defibrillation in young competitive athletes with sudden cardiac arrest (SCA). The purpose of this study was to investigate the details and outcomes of resuscitation in a cohort of intercollegiate athletes with SCA. Nine cases of SCA in intercollegiate athletes occurring between 1999 and 2005 were identified through prior research and public media. A detailed questionnaire was completed by the certified athletic trainer involved in the resuscitation, and direct phone follow-up was achieved in every case. Nine intercollegiate athletes with SCA (4 basketball, 2 football, 2 lacrosse, and 1 swimming) had an average age of 21 years (range 18-30 years). All 9 athletes had a witnessed collapse, 7 occurred during practice, 1 during competition, and 1 during organized weight training. Cardiopulmonary resuscitation (CPR) was initiated within 30 seconds after cardiac arrest in 6 cases and by 1 minute in 2 additional cases. An automated external defibrillator (AED) was provided by an athletic trainer in 5 cases and by arriving emergency medical services (EMS) in 4 cases. The initial cardiac rhythm was confirmed or suspected ventricular fibrillation in 7 athletes, pulseless idioventricular rhythm in 1 case, and unknown in 1 case. In 7 cases a shock was deployed, with an average time from cardiac arrest to defibrillation of 3.1 minutes (range 1-7.5 minutes). The average time from arrest to defibrillation decreased significantly if an AED was provided by an athletic trainer as compared with the responding EMS (1.6 vs 5.2 minutes; P = .046). Eight of the 9 athletes died. The underlying cause of sudden cardiac death was hypertrophic cardiomyopathy in 5, commotio cordis in 2, and myocardial infarction in 1. Diagnostic studies in the survivor demonstrated no structural heart disease or precise cause of SCA. Despite witnessed collapse, immediate CPR, and prompt AED use in most cases, early defibrillation showed limited success, and survival was less than expected in this small cohort of intercollegiate athletes. More research is needed to determine the effectiveness of early defibrillation and factors that affect survival in young athletes with SCA.