Sudden Cardiac Arrest during Participation in Competitive Sports

Abstract

BACKGROUND The incidence of sudden cardiac arrest during participation in sports activities remains unknown. Preparticipation screening programs aimed at preventing sudden cardiac arrest during sports activities are thought to be able to identify at-risk athletes; however, the efficacy of these programs remains controversial. We sought to identify all sudden cardiac arrests that occurred during participation in sports activities within a specific region of Canada and to determine their causes. METHODS In this retrospective study, we used the Rescu Epistry cardiac arrest database (which contains records of every cardiac arrest attended by paramedics in the network region) to identify all out-of-hospital cardiac arrests that occurred from 2009 through 2014 in persons 12 to 45 years of age during participation in a sport. Cases were adjudicated as sudden cardiac arrest (i.e., having a cardiac cause) or as an event resulting from a noncardiac cause, on the basis of records from multiple sources, including ambulance call reports, autopsy reports, in-hospital data, and records of direct interviews with patients or family members. RESULTS Over the course of 18.5 million person-years of observation, 74 sudden cardiac arrests occurred during participation in a sport; of these, 16 occurred during competitive sports and 58 occurred during noncompetitive sports. The incidence of sudden cardiac arrest during competitive sports was 0.76 cases per 100,000 athlete-years, with 43.8% of the athletes surviving until they were discharged from the hospital. Among the competitive athletes, two deaths were attributed to hypertrophic cardiomyopathy and none to arrhythmogenic right ventricular cardiomyopathy. Three cases of sudden cardiac arrest that occurred during participation in competitive sports were determined to have been potentially identifiable if the athletes had undergone preparticipation screening. CONCLUSIONS In our study involving persons who had out-of-hospital cardiac arrest, the incidence of sudden cardiac arrest during participation in competitive sports was 0.76 cases per 100,000 athlete-years. The occurrence of sudden cardiac arrest due to structural heart disease was uncommon during participation in competitive sports. (Funded by the National Heart, Lung, and Blood Institute and others.)

Medical encounters (including injury and illness) at mass community-based endurance sports events: an international consensus statement on definitions and methods of data recording and reporting

“…Non-reported medical problem A medical problem experienced by an athlete participating in an event, where "the athlete decides athlete decides not to seek assistance from the event medical team, or seeks assistance outside of the event medical team" Medical encounter A reported medical problem that is an "interaction between the medical team and a race participant requiring medical assistance or evaluation [7,8], taking place from the official start of the event, up to 24 hours after the official cut-off time of the event" Minor medical encounter A medical encounter that: 1. is not significant or severe enough to result in withdrawal of the athlete from the event following assessment by the medical staff, or 2. does not require admission and supervised medical care at race medical facilities (on the race course, or at the end of the event) or transfer to a hospital for supervised medical care Moderate medical encounter A medical encounter that: 1. is significant (severe) enough to result in withdrawal of the athlete from the event following assessment by the medical staff, or 2. is non-life threatening but requires medical assessment and admission to the event medical facilities with supervised medical care, or 3. is non-life threatening but requires referral or transfer to a hospital Serious / life-threatening medical encounter A medical encounter that is known to be life-threatening and requires immediate emergency medical treatment with 1. either admission to a high-care (intensive care and observation) medical area at the event, or 2. transport (with or without admission) to a hospital Event related sudden cardiac arrest (SCA) A medical encounter (cardiac arrest) that requires immediate cardiopulmonary resuscitation (including defibrillation), where the medical problem resulting in cardiac arrest was: 1. deemed to be directly related to the event, and 2. the onset of the medical problem occurred during the event or within 1-24 hours of the finish time [47] [48,49] * Event related sudden cardiac death (SCD)…”

“…A medical encounter that resulted in sudden cardiac death (SCD) from a SCA, where the medical problem resulting in SCD was: 1. deemed to be directly related to the event, and 2. the onset of the medical problem occurred during the event or within 1-24 hours of the finish time [47] [48,49]* Event related sudden death A medial encounter that resulted in sudden death from non-cardiac causes, where the medical problem resulting in death was: 1. deemed to be directly related to the event, and 2. the onset of the medical problem occurred during the event or within 1-24 hours of the finish time [47] [48,49]* *In order to compare sudden cardiac arrest (SCA) , sudden cardiac death (SCD) and event related sudden death data to previously reported data it is critical to record, the timing of the cardiac arrest or death in one of three possible time periods as follows: a) during the event, b) immediately after finishing and up to 1 hour after the event, and c) between 1 and 24 hours after the event.…”

CO2-related vasoconstriction superimposed on ischemic medullary brain autonomic nuclei may contribute to sudden death

“…A thorny lingering subset in the mystery of unexpected sudden deaths are athletes who are considered healthy, only to drop dead during a competitive sporting event [25]. The clinicopathological common denominator in all of these sudden deaths could be exercise-induced tachycardia which may occasionally cause transient ischemia of the heart and solitary tract nucleus, not readily apparent at general autopsy.…”

“…It is interesting that several years prior to the publication of any of these clinical trial results [2,8,[23][24][25], the American Heart Association revised its guidelines for cardio-pulmonary resuscitation (CPR) outside of a hospital settingto minimize mouth-to-mouth ventilation and become 'Hands-only CPR', focusing largely on manual chest compressions.…”

To screen or not to screen, what do the Pacific Island athletes teach us?

“…The high incidence of SCD may be partly a chance finding given the relatively small population studied, but it may also be related to the ethnic profile and background of athletes in this geographically distinct area. In the literature, estimates of the incidence of cardiac arrest among athletes has varied widely depending on the definition (whether survivors of cardiac arrest are included or not), methodology and athlete population studied, with most estimates falling between 1:50,000 and 1:80,000 athlete years [4,9]. However, some subgroups such as men, black athletes and basketball players, appear to be at significantly higher risk, with risk estimates closer to this report from the Pacific Islands [4].…”