Bystander interventions and survival after exercise-related sudden cardiac arrest: a systematic review

Abstract

ObjectiveTo evaluate the provision of bystander interventions and rates of survival after exercise-related sudden cardiac arrest (SCA).DesignSystematic review.Data sourcesMEDLINE, EMBASE, PubMed, CINAHL, SPORTDiscus, Cochrane Library and grey literature sources were searched from inception to November/December 2020.Study eligibility criteriaObservational studies assessing a population of exercise-related SCA (out-of-hospital cardiac arrests that occurred during exercise or within 1 hour of cessation of activity), where bystander cardiopulmonary resuscitation (CPR) and/or automated external defibrillator (AED) use were reported, and survival outcomes were ascertained.MethodsAmong all included studies, the median (IQR) proportions of bystander CPR and bystander AED use, as well as median (IQR) rate of survival to hospital discharge, were calculated.ResultsA total of 29 studies were included in this review, with a median study duration of 78.7 months and a median sample size of 91. Most exercise-related SCA patients were male (median: 92%, IQR: 86%–96%), middle-aged (median: 51, IQR: 39–56 years), and presented with a shockable arrest rhythm (median: 78%, IQR: 62%–86%). Bystander CPR was initiated in a median of 71% (IQR: 59%–87%) of arrests, whereas bystander AED use occurred in a median of 31% (IQR: 19%–42%) of arrests. Among the 19 studies that reported survival to hospital discharge, the median rate of survival was 32% (IQR: 24%–49%). Studies which evaluated the relationship between bystander interventions and survival outcomes reported that both bystander CPR and AED use were associated with survival after exercise-related SCA.ConclusionExercise-related SCA occurs predominantly in males and presents with a shockable ventricular arrhythmia in most cases, emphasising the importance of rapid access to defibrillation. Further efforts are needed to promote early recognition and a rapid bystander response to exercise-related SCA.

Sudden cardiac arrest in athletes and strategies to optimize preparedness

“…Exercise‐induced SCA is more likely to present with shockable rhythms such as VT or VF, making the use of an AED imperative for optimal outcomes. However, AED use remains suboptimal in this population 69,70 . For example, a prospective cohort study conducted in Germany and France found that an AED was utilized in only 7.5% of 147 cases of sports‐related SCA, despite those who received defibrillation having a survival rate of nearly 91% 70 .…”

Morte Súbita No Esporte

“…Na maioria dos casos descritos na literatura afirmam que a morte súbita se apresenta por meio de uma arritmia ventricular com ritmo chocável, o que justifica a relevância do uso imediato da desfibrilação (GRUBIC et al, 2022;DEFRODA et al, 2019;JONG et al, 2020). Nesse sentido, esse evento apesar de raro e dramático pode ser amenizado, por meio da adoção do tratamento adequado e de medidas preventivas, a fim de prevenir mortes e sequelas graves.…”

“…O resultado constatou que tanto a RCP do espectador bem como a utilização do DEA está em associação com as taxas de sobrevida após a parada cardíaca súbita vinculada ao exercício. No entanto, ressalta-se a necessidade de ampliação na promoção do conhecimento e na identificação precoce do evento, bem como da realização de uma ação ágil do espectador mediante a parada cardíaca súbita vinculada ao exercício (GRUBIC et al, 2022).…”

Educating sports people about CPR and first aid in general practice: the Savtember project

“…During an exercise-related sudden cardiac arrest, bystander automated external defibrillator (AED) use occurred in a median of 31% (Grubic et al, 2021). Hence, increasing knowledge of and training in basic life support (BLS) and the use of defibrillators among the lay public would be expected to improve the survival and prognosis of out-of-hospital cardiac arrest (Ro et al, 2019;Vancini et al, 2019;Yu et al, 2020).…”