Sudden Cardiac Arrest. It doesn’t happen often. But when it does, it is very serious and often fatal.
When it happens to a finely conditioned athlete like Buffalo Bills safety Damar Hamlin, the world takes pause.
How can an elite, 24-year-old athlete like Hamlin go down with such a serious medical condition? And what does it mean to the rest of us, who might be high school or amateur athletes or their parents?
How can we proceed in our sport with confidence, knowing that sudden cardiac arrest exists? And the threat, no matter how rare, still strikes the amateur marathon runner or NCAA basketball star from time-to-time.
For answers, The Villager turns to University Hospitals, the Official Healthcare Provider for the Cleveland Browns. Answers are provided by:
Dr. Trevor Jenkins, a cardiologist with UH Harrington Heart & Vascular Institute with an emphasis on sports cardiology. Dr. Jenkins practices at UH Westlake Health Center.
- Dr. Shaun Harper, a cardiologist with UH Harrington Heart & Vascular Institute. Dr. Harper practices at UH Westlake Health Center and UH St. John Medical Center.
What is Cardiac Arrest?
Cardiac arrest occurs when there is a sudden stop of heart muscle pumping function resulting in the cessation of blood flow to other vital organs of the body and loss of consciousness.
There are many different causes of cardiac arrest including genetic anomalies of the heart’s electrical system, weakening of the heart muscle, but the most common cause is coronary artery disease. In Damar Hamlin’s case the current thought is that he may have suffered a cardiac arrest from a syndrome called commotio cordis. This is a very rare cause of cardiac arrest that is due to a sudden blow to the chest (typically a small object such as a baseball, hockey puck, or lacrosse ball) at a specific and critical time during the cardiac electrical cycle.
Resource: Heart Rhythm Society patient hand out on sudden cardiac death: https://upbeat.org/patient-information-sheets#sudden-cardiac-arrest
Is Cardiac Arrest different from a heart attack?
Cardiac arrest results from a malfunctioning of the heart’s electrical system. The heart requires a coordinated series of electric impulses from the top (atria) to the bottom pumping chambers (ventricles) to allow the normal rhythmic pumping of blood to support the body. This is different from a heart attack (myocardial infarction) which is caused by a blocked heart artery which prevents delivery of oxygen to heart muscle causing the heart muscle to die. A heart attack is a “plumbing” problem of the heart different from the electrical problem that causes sudden cardiac death.
How unusual is Cardiac Arrest?
In the US, sudden cardiac death from cardiac arrest occurs 400,000 a year outside of a hospital and results in 50% of heart disease deaths.
In athletes, this condition is much less common. A review of published research on sudden cardiac death in college athletes estimated that there is a 1 in 53,703 chance of cardiac arrest. This was slightly more common in men (1 in 37,790) than women (1 in 121,593) and that there was a difference by sport (basketball 1 in 8978, soccer 1 in 23,689, football 1 in 35,951).
Sudden cardiac death in athletes reference, Dr. Wasfy et al. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4969030/
How are athletic facilities prepared to handle Cardiac Arrest?
Athletic facilities are prepared by having an automated external defibrillator (AED) on site for immediate opportunity to shock a victim of cardiac arrest back to a normal heart rhythm along with trained personnel (athletic trainers, sports medicine physicians, nurses) who are certified by the American Heart Association in Basic Life Support training for CPR and Advanced Cardiovascular Life Support (ACLS) to provide immediate resuscitation efforts to treat cardiac arrest.
What is the prognosis or recovery scenario for a Cardiac Arrest patient? Can they return to sport?
Prognosis in cardiac arrest is related to time period before effective CPR chest compressions are started as well as the length that CPR resuscitation efforts last. Recovery efforts from cardiac arrest can take weeks to years depending on the condition of the person before cardiac arrest and the medical origin and complications resulting from the cardiac arrest event.
Professional athletes have returned from cardiac arrest events. Christian Eriksen who suffered a cardiac arrest at the January 2020 Euro 2020 soccer tournament on the field during a match playing for Denmark, was able to return to play for his country’s national team again in June 2021. He required an implantable defibrillator ICD) to prevent a repeat episode of cardiac arrest. Return to play decisions require an individualized shared decision making approach between athlete and medical team that takes into account their underlying medical condition, current ongoing medical treatments, and sport specific limitations. Sports with low impact and low peak exercise intensity (golf, bowling) will have different return to play criteria than sports with high risk of body collision (football, basketball, skiing).
How can Cardiac Arrest be prevented? Are there risk factors assessed in athletic physicals?
Cardiac arrest can be prevented through routine medical care including pre-participation cardiovascular screening by a health professional. The American Heart Association/American College of Cardiology (AHA/ACC) society recommendations endorse a strategy of universal focused medical history and physical examination using the Pre-Participation Physical Examination (PPE-4) template. For adult athletes, risk factors assessed include family history of heart disease questions, blood pressure measurement, screening of use of illicit substances or unregulated supplements, and assessment of other medical conditions (high cholesterol, diabetes, sleep apnea, smoking) that are conventional heart disease risk factors.
Should EKGs (ECGs) be mandatory for all high school and amateur athletes?
At this time, the American Heart Association/American College of Cardiology (AHA/ACC) society recommendations do not endorse universal ECG screening of high school age athletes and youth due to the high rate of false positive screening findings on testing for the entire age cohort. ECG screening performed based on the findings of the in-person pre-participation cardiovascular screening by a health professional are recommended (such as hearing a heart murmur) are recommended. There can be overlap in normal athletic remodeling changes to the heart and abnormal ECG findings in non-athletes that account for this discrepancy. Sports cardiology at Rainbow Babies & Children help assist in evaluation of these athletes under the age of 18.
2017 America College of Cardiology Sports Cardiology consensus statement on Providing Cardiovascular Care to Competitive Athletes and Highly Active People: https://www.jacc.org/doi/10.1016/j.jacc.2017.08.055
What can I do, as a high school athlete or parent, to minimize the risk of Cardiac Arrest?
See 2 questions above for similar recommendations.
If someone near you suffers cardiac arrest, what should you do?
As for parents feeling prepared to minimize risk on site, knowledge of where the AED is located at each facility you are performing is the best first step. Enrolling in a BLS class sponsored by the American Heart Association can also help reduce the risk that someone who goes into cardiac arrest at an athletic event has a delay in effective CPR.
Doctor, what are the most important facts the public needs to know about Cardiac Arrest?
The most important fact to remember about cardiac arrest is that seconds matter to when effective CPR (cardiopulmonary resuscitation) chest compressions are started. If you are trained in this basic life support skill, checking for a pulse and immediately starting CPR may be the difference in saving someone’s life. If you are not trained in CPR, alerting others people around that someone is not breathing and doesn’t have a pulse is also important as well as activating the emergency response system by calling 911. Community-wide, training in CPR can save a life as we saw this week with Bills’ player Damar Hamlin.
The best possible outcome from this very tragic event may be that it has highlighted the importance of early high quality CPR. High quality CPR is much different than often pictured on TV or in movies. Taking the time to get yourself and your family trained in high quality CPR can save lives and as noted above can improve the neurologic outcomes in survivors of cardiac arrest.