For Young Athletes, a Key Save
New Guidelines Aim to Prevent Deaths of School, College Players From Sudden Cardiac Arrest

By Jennifer Huget
Special to The Washington Post
Tuesday, April 10, 2007

The last thing you might expect to see at a school sporting event is a student having a fatal heart attack. But sudden cardiac arrest accounts for possibly hundreds of such deaths a year among young competitive athletes in the United States, making it a leading cause of death for this population, according to some experts.

In an effort to reduce this toll, a task force convened by the National Athletic Trainers' Association issued guidelines last week to help high school and college athletic programs respond faster to sudden cardiac arrest, or SCA.

SCA occurs when an electrical malfunction in the heart causes it to contract rapidly and erratically so that it stops pumping blood. Though victims are often later found to have underlying structural heart abnormalities that increase the risk of such malfunctions, for most, SCA is the first sign that something is amiss. (One of those abnormalities, hypertrophic cardiomyopathy -- a thickening of the heart muscle that makes it harder for the heart to pump -- affects one in 500 people, according to the American Heart Association, and isn't typically discovered in the physicals that most students take before joining athletic teams.)

Strenuous physical activity is thought to trigger SCA, 90 percent of whose victims are male, according to physician Jonathan Drezner, associate director of the sports medicine program at the University of Washington in Seattle and lead author of the task force's consensus statement.

SCA can be halted by speedy use of a defibrillator, which delivers an electric shock that can correct the abnormal heart rhythm. But the window for use is small -- ideally, within five minutes after collapse -- and too often help comes too late or not at all. In the absence of a defibrillator, cardiopulmonary resuscitation (CPR) may improve chances of survival, by helping circulate some blood to the lungs and brain. But it won't correct the arrythmia.

"Survival in young athletes with cardiac arrest has been very poor for many years, around 10 percent," Drezner said. "Our goal is to help high school and college athletic programs prepare for and respond to cardiac emergencies."

The task force issued its statement, which emphasizes comprehensive emergency planning, in the April edition of Heart Rhythm, the journal of the Heart Rhythm Society. Among the top recommendations for schools:

· Decide who's going to do what -- including who's going to communicate with whom -- in an emergency, and practice your response plan.

· Train key people in CPR and the use of automated external defibrillators, or AEDs.

· Ensure access to an AED during practices and sporting events.

· Coordinate efforts with the local emergency medical service.

A fast response can make a difference when SCA strikes a student athlete. In March 2006, Vanderbilt University basketball player Davis Nwankwo, a 19-year-old from College Park, collapsed during team practice in Nashville. The athletic staff sprang into action: An assistant coach called 911 as the trainer summoned an AED and used it and CPR to revive Nwankwo. Nwankwo survived.

Andrew Helgeson did not. An accomplished 18-year-old athlete at Montgomery Blair High School, Helgeson died of SCA at his home in May 2005. His parents, Rita and Richard Helgeson, have honored their son's memory by campaigning for legislation requiring AEDs in all Maryland high schools -- though they acknowledge this would not have saved their son. Such a law went into effect last July. The Helgesons also advocate widespread screening of children and teens for heart abnormalities and adding CPR and AED training to high school health curricula.

"Sudden cardiac arrest is such a devastating event," Richard Helgeson said. "You have about 10 minutes [from collapse to death]. An AED can bring you back to life. The only thing that will save you is an AED. You get the shock and live, or you don't and you die."

But addressing SCA is not as simple as requiring AEDs in schools, Drezner notes. Portable, public-use AEDs cost about $1,500 each, a cost that's prohibitive for many schools, he says. Even if AEDs are donated, he adds, school staff must receive adequate training in their use -- something that doesn't always happen. Potential legal ramifications of having laypeople use AEDs discourage some schools from acquiring them. And even when a school is AED-equipped, Drezner says, sometimes people who need to use the devices don't know a school has them or where the devices are stored.

The Helgesons are undaunted. "If this could happen to Andrew, it could happen to anybody," Richard Helgeson said. "If I put five AEDs in every school and it saves one kid, I'd be happy." ·

Some resources on SCA:

· Sudden Cardiac Arrest Foundation ( http://www.sca-aware.org)

· American Heart Association ( http://www.americanheart.org)

Jennifer Huget is a frequent contributor to the Health section. Comments:health@washpost.com.