Little League cardiac arrest highlights need for heart screenings

By Dr. Marc Siegel

Published May 29, 2012

FoxNews.com

VIDEO

Sean Neely, 12, was playing catcher at a little league game in Freeport, Pennsylvania earlier this month when he was hit in the chest with a foul ball. For almost anyone, this would be just a bruise. But for this boy, the thump to the chest came at exactly the most vulnerable moment in the cardiac cycle, sending his heart into a lethal arrhythmia; probably ventricular fibrillation, where the heart quivers and then stops.

The condition where trauma to the chest causes this to happen is known as commotio cordis. It is very rare, and only 15 percent of people who experience it survive. Luckily for Sean, his two coaches initiated Cardio Pulmonary Resuscitation right away (which preserves about 30 percent of cardiac output), and he came around. He was airlifted to Children's Hospital of Phil adelphia, a top notch facility where he was tested and observed for three days, and was reportedly found to have a normal heart. It was a medical miracle that he suffered no damage from the heart stoppage.

Most people who develop this problem require immediate defibrillation; where electric shocks are administered to the chest to restore a normal beat. There are laws to ensure that automated external defibrillators are available in all fifty states, and good Samaritan laws to protect those who use them. They are easy to use; you put the pads on the chest and the defibrillator does the rest - sensing the rhythm and administering a shock if needed. The American Heart Association estimates that AEDs could save 20,000 lives when they are used promptly.

 

Sean Neely wasn't one of those 20,000 -- the AED wasn't necessary in his case, though one was available on the scene. His heart rhythm returned to normal spontaneously, and the CPR preserved blood flow to Sean's brain and other vital organs until that happened.

Sean's unlucky cardiac arrest wasn't the result of an underlying problem with his heart. Pre-screening by a pediatrician or even a heart specialist could not have predicted this event. Nevertheless, any time a young person sustains a heart attack or arrhythmia while engaging in sports it is a good time to issue a reminder: All teens should see their pediatrician before competing.

I believe these teens should all have at least an EKG as well as a careful physical examination, with special attention paid to their heart sounds and abnormalities on the EKG which might predict an arrhythmia. Any heart murmurs should precipitate an echocardiogram of the heart to make sure there are no problems with the valves or walls of the heart. Any abnormality should immediately be discussed with a cardiologist.

Keep in mind that 100,000 young athletes die of cardiovascular events while participating in sports, which is more than those who die in car accidents. The most common cause is from hypertrophic cardiomyopathy, an abnormal thickening of the wall of the heart that is difficult to diagnose without an echocardiogram.

 

Sean was lucky; he owes a lot to his coaches and to the two nurses who were on the scene. Others aren't as fortunate - we need to keep a special eye out for heart problems as our teens engage in competitive sports. They are too precious to lose.

Marc Siegel MD is an associate professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center. He is a member of the Fox News Medical A Team and author of The Inner Pulse; Unlocking the Secret Code of Sickness and Health.

Study Supports ECG Screening During Pre-Participation Exam to Identify Athletes at Risk of Sudden Cardiac Death

Released: 4/25/2012 3:30 PM EDT

Source: American Medical Society for Sports Medicine

Newswise — ATLANTA, Ga. – University of Washington researcher Jessie Fudge, MD received the Dr. Harry L. Galanty Young Investigator’s Award for excellence in sports medicine research at the 21st American Medical Society for Sports Medicine Annual Meeting in Atlanta, Ga. on April 24, 2012.

Dr. Fudge’s study “Cardiovascular Screening in Young Athletes : A Prospective Study Comparing the PPE Monograph 4th Edition and Electrocardiogram” looked at the challenging issue of identifying young athletes with undiscovered cardiovascular issues. It concluded that a standardized history and physical yields a high false-positive rate in a young active population and ECG screening is feasible and provides superior sensitivity and specificity.

“ECG screening, when interpreted with modern criteria for youth athletes, provides better sensitivity and specificity compared to current screening guidelines,” said Dr. Fudge. “The addition of ECG screening to the pre-participation exam may better identify athletes at risk for sudden cardiac death.”

A total of 1,339 subjects were screened. Echocardiograms were completed in 586 (44%) for concerning medical history (24%), family history (12%), physical exam (8%), or ECG (5%). Six (0.45%) were identified with a disorder known to cause sudden cardiac death (SCD). The sensitivity and specificity to detect disorders at risk of SCD were respectively 33% and 69% for history alone, 16% and 91% for physical exam, and 100% and 95% for ECG. Fifty percent of disorders known to cause sudden cardiac death were detected by ECG alone.

Co-authors of the research are Jonathan Drezner, MD; Kimberly Harmon, MD; David Owens, MD; Jordan Prutkin, MD, MHS; Irfan Asif, MD; Alison Haruta, Hank Pelto, MD; Ashwin Rao, MD; and Jack Salerno, MD all from the University of Washington

The conference featured lectures and research addressing the most challenging topics in sports medicine today including prevention of sudden death, cardiovascular issues in athletes, concussion, biologic therapies, and other controversies facing the field of sports medicine.

More than 1,200 sports medicine physicians from across the United States and 12 countries throughout the world attended the meeting.

The Galanty Young Investigator’s Award is presented at the AMSSM Annual Meeting for the most outstanding research presentation by a member who is a sports medicine fellow or who has rec ently completed fellowship training. The award was established in 2003 to honor Harry Galanty, MD, a charter member of the AMSSM, who passed away in 1999 at the age of 36. Dr. Galanty’s contributions to sports medicine combined clinical service, and a commitment to teaching and research.

Dr. Fudge is completing a fellowship in primary care sports medicine at the University of Washington. She completed a family medicine residency at UW.

The AMSSM is a multi-disciplinary organization of sports medicine physicians whose members are dedicated to education, research, advocacy, and the care of athletes of all ages. Founded in 1991, the AMSSM is now comprised of more than 2,000 sports me dicine physicians whose goal is to provide a link between the rapidly expanding core of knowledge related to sports medicine and its application to patients in a clinical setting.

A race against time

 

One important skill — CPR — was as responsible as any for saving 11-year-old player.

Pete Iorizzo, Commentary

Published 11:11 p.m., Saturday, April 21, 2012

• 
  View from the pitcher's mound at Cook Park little league "majors" field in Colonie April 18, 2012. (John Carl D'Annibale / Times Union)
  View from the pitcher's mound at Cook Park little league "majors"...

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Brian Manion, the co-president of South Colonie Youth Baseball, put $2,000 on his personal credit card Tuesday to buy his league a defibrillator.
"I'm sure they'll figure out how to reimburse me later," he said. "I just thought we needed to do this now."
Goldstock's, the sporting goods store in Scotia, sold out its entire stock of "heart guard" shirts, or padded undershirts marketed to protect children from blows to the chest.
Ditto for Play it Again Sports in Latham.
"Tons!" a sales associate said when asked how many heart guard shirts had been sold since Monday evening, when an 11-year-old Colonie Little League player nearly died at home plate after being hit in the chest with a pitch.
The story had a happy ending. Many don't. In youth leagues areawide, the near tragedy at Cook Park has jolted parents and coaches, sending them scrambling to ensure we don't test the odds again.
That's a good thing — but only so long as we're not misdirecting our energy toward unproven solutions or, worse, begetting fear and hysteria without cause.
What we really need to do is take a deep breath.
Because there is a very easy way to dramatically improve the safety of our playing fields, without spending a dime.
First, a little perspective: Most of us never had heard of commotio cordis before Monday, and that's because it happens only a handful of times each year, affecting a minuscule percentage of the millions who play youth sports.
Of course, that doesn't diminish the consequences for victims' families. Somewhere between 65 and 90 percent of commotio cordis cases end in tragedy. A 12-year-old lacrosse player from Rochester died just this past February.
Commotio cordis happens when a spherical object strikes a specific part of the heart at a precise fraction of a second between beats. The result is cardiac arrest.
But even if we understand what can turn a Little League fastball deadly, we're much less certain about what can make it safe.
Using swine that were placed under anesthesia and then fitted with heart guard shirts, the National Operating Committee on Standards for Athletic Equipment has tested most of the products now flying off the shelves of local sporting good stores.
The results: There's no proof they're effective.
"As a general rule, there's no scientific evidence that any of those products provide less protection or more protection," said Mike Oliver, the NOCSAE's executive director.
More worrisome, the research showed some of the shirts may actually increase the chances of commotio cordis.
How? For reasons that are unclear, balls traveling faster than 40 miles per hour are less likely to cause commotio cordis than those travelling a little slower.
The padding of the heart guard can take a 70-mile-per-hour fastball and soften the blow enough to create the impact of a 35 mph pitch. As counterintuitive as it sounds, the slower pitch may be more dangerous.
"That was a real surprise to us," Oliver said.
There's another problem: Equipping our kids with gear that's of dubious effectiveness could provide false peace of mind.
Just ask Karen Acompora. Her son Louis died in 2000, at age 14, while playing goalie in a Long Island high school lacrosse game.
"I hear parents say, 'Oh, it's fine, my kid is wearing a chest protector," Acompora said.
"Well," she said, "so was mine."
Soon after their son's death, Karen and her husband, John, became champions of legislation that makes it mandatory for every New York public school to have a defibrillator.
That's important, because a defibrillator offers the best chance of restarting the heart of someone who has suffered commotio cordis.
But Louis's Law, as it's known, doesn't cover recreational leagues, and at a cost of $1,200 to $2,000, defibrillators may fall beyond some leagues' means.
Those leagues still can take a major step toward making all their athletes safer, at virtually no cost.
How?
They can make every single one of their coaches learn CPR.
The lesson takes 15 to 20 minutes, and it can be done simply by watching instructional videos on the American Heart Association's YouTube site.
The Colonie Little League player is alive today because of the terrific teamwork executed by the coaches, first responders and emergency crews.
But if Frank Prevratil, the league president, hadn't begun chest compressions right away, and if Colonie police officer Brian Curran hadn't continued CPR when he arrived on scene, the EMS crew equipped with a defibrillator might not have saved the boy's life.
"In most communities, the first responders all carry some form of a defibrillator," said Bob Elling, a Colonie paramedic who serves on the board of the American Heart Association.
"But in order for the defibrillator to be successful, we really need to prime the pump. We need to start CPR immediately."
Elling has been a paramedic for 35 years.
"I've never once — not once — seen a case where someone survived and there wasn't someone who started CPR before we got there," he said.
The American Heart Association is pushing a law that would make it mandatory for all high school students to learn CPR before graduating.
Even if the last thing schools need is another mandate, surely asking every student to spend one class period learning the proper way to perform chest compressions wouldn't be too burdensome.
"You don't need anything special," Elling said. "There's no special equipment. Anybody could teach the class. You go to a website, watch a video demonstration, borrow a mannequin from the local rescue squad and have each student try the compressions.
"That's it. One class period."
We never can create enough rules or pass enough laws or develop enough safety equipment to remove all the danger from sports.
But we all can — and should — invest the 20 minutes it takes to be prepared for the worst. It will save lives. An 11-year-old boy is proof.
piorizzo@timesunion.com • 518-454-5425 • @peteiorizzo

Read more: http://www.timesunion.com/sports/article/A-race-against-time-3500588.php#ixzz1sm8gqtRj

Young batter hit by pitch in Colonie suffers rare heart stoppage, but quick response makes the difference

Teamwork proves vital as Little Leaguer revived

Young batter hit by pitch in Colonie suffers rare heart stoppage, but quick response makes the difference

Pete Iorizz, Times UnionCopyright 2012 Times Union. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

By Pete Iorizzo

Updated 09:43 p.m., Tuesday, April 17, 2012

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The heart of an 11-year-old Little League baseball player started beating again Monday evening moments after he was hit by a pitch and nearly died at home plate.
The boy was batting in a Colonie Little League game at Cook Park when he was struck by a pitch and crumpled to the dirt. The pitch had hit him in the chest and stopped his heart.
A coach and police officer performed CPR before a defibrillator brought the boy back to life. He was recovering Tuesday at Albany Medical Center, police and coaches said.
"This was about everyone working together as a team," said Frank Prevratil, the president of Colonie Little League.
Prevratil, who also was the coach of the other team, was the first to begin CPR.
"There was no panic from anyone, no hysteria," Prevratil said. "Everyone did exactly what they were supposed to do."
Police and Colonie Little League officials declined to release the boy's name.
The boy may have suffered a condition called commotio cordis, which occurs when there is a blow to the heart at precisely the right fraction of a second to disrupt the organ's electric rhythms.
About 65 percent of commotio cordis victims die, though it accounts for only three or four deaths nationally each year, said Peter Berry, deputy chief of the Colonie EMS department.
"In my 23 years in the department, this is the first call for of this specific type of incident that I can recall," Berry said.
The call came into Colonie EMS dispatchers at 6:37 p.m. Monday, seconds after the boy had been hit, Berry said.
The boy's coach, Mike Martin, bolted from the dugout and realized the boy was having trouble breathing, Prevratil said.
Martin declined comment, other than to say the boy was doing well Tuesday.
When Prevratil saw the boy's coach needed further assistance, he rushed from his own dugout. On his way to home plate, he heard someone from the stands shout, "Call 911!"
While Martin and Prevratil tended to the boy, he slipped out of consciousness. That's when Prevratil began CPR.
He performed chest compressions for only about 30 seconds before Colonie police officer Brian Curran arrived on the scene, at 6:42 p.m., Colonie Police Lt. Robert Winn said.
Colonie Police declined to make Curran available for comment.
Curran took over CPR, but it was only two minutes before the EMT team reached the boy with a defibrillator.
His heart restarted while he still was lying in the batter's box, Prevratil said, and he was taken away by ambulance.
By that time, all the other players had been moved to another field, where they couldn't see what was happening at home plate.
"It was amazing to see everyone working so calmly," Prevratil said. "Everyone did what they were trained to do."
The umbrella Little League organization mandates that at least one coach of every team participate in a two-hour safety course, which covers everything from first aid to life-threatening incidents.
"I'm very proud of that training and the way it worked," Prevratil said.
In 2000, commotio cordis was responsible for the death of a 14-year-old lacrosse player from Long Island named Louis Acompora.
His death led to what is now called, "Louis's Law," which mandates all New York State public schools have defibrillators available at sporting events. But the law does not govern recreational leagues.
piorizzo@timesunion.com * 518-454-5425 * @PeteIorizzo

Read more: http://www.timesunion.com/local/article/Teamwork-proves-vital-as-Little-Leaguer-revived-3488642.php#ixzz1sOrl6jME

Look for Warning Signs of Sudden Death in Kids

By Nancy Walsh, Staff Writer, MedPage Today

Published: March 26, 2012

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco.

Action Points

·         Awareness of warning signs and family history are crucial for the prevention of sudden cardiac arrest in young people.

·         Note that the statement recommends that clinicians recognize the warning signs and symptoms of sudden cardiac arrest, including those that may be incorrectly attributed to noncardiac diseases and, thus, delay correct diagnosis.

Awareness of warning signs and family history are crucial for the prevention of sudden cardiac arrest in young people, according to a new policy statement from the American Academy of Pediatrics.

Pediatric sudden cardiac arrest can be lethal within minutes if unrecognized and untreated, and some 2,000 related deaths are thought to occur in the U.S. each year, according to the statement, which was published online ahead of print in the April issue of Pediatrics.

"Although [sudden cardiac arrest] may be the sentinel event, symptoms in patients with structural-functional or primary electrical disorders may, in fact, be relatively common," the statement reads.

Symptoms can include chest pain, dizziness, exercise-induced syncope, and dyspnea, which may have bee n disregarded by the patient and family; a detailed history also may reveal the sudden, unexplained death of a young relative.

In fact, estimates suggest these warning signs may be present in up to half of cases of sudden cardiac arrest in children.

The most common underlying causes of sudden cardiac arrest in this age group are structural or functional disorders such as hypertrophic cardiomyopathy and coronary artery anomalies, and primary cardiac electrical disorders such as familial long QT syndrome and Wolff-Parkinson-White syndrome.

The most frequent immediate event is a ventricular tachyarrhythmia, the statement authors noted.

Some types of arrhythmias, such as torsades de pointes, can be transient and may appear similar to seizures, which highlights the importance of accurate diagnosis.

The statement recommends that clinicians recognize the warning signs and symptoms of sudden cardiac arrest, including those that may incorrectly be attributed to noncardiac diseases and, thus, delay correct diagnosis.

For example, if the patient is thought to be experiencing a seizure, the likely referral may be to a neurologist, which could delay the diagnosis -- with potentially disastrous results.

Similarly, if dyspnea is the presenting symptom, the workup may focus on a respiratory etiology, so a lack of response to initial treatment should trigger a reconsideration of potential cardiac causes, they suggested.

The statement also addressed the issue of screening young athletes before permitting sports participation.

A variety of risk-assessment tools have been used, and although these have not been validated or assessed for sensitivity or specificity, expert opinion currently emphasizes the importance of these "ominous" findings on a preparticipation screen:

·         A history of fainting or having a seizure, especially during exercise

·          Past episodes of chest pain or shortness of breath with exercise

·          A family member with unexpected sudden death or a condition such as hypertrophic cardiomyopathy or Brugada syndrome

The academy also considered the role of ECG screening for young athletes and referred to earlier American Heart Association guidelines that did not endorse widespread use of this test, citing the possibilities of false-positive and false-negative results, cost, and medicolegal problems.

"Wide-scale E CG screening would require a major infrastructure enhancement not currently available in the U.S.," the statement pointed out, and called for additional data and debate on the subject.

Another recommendation was regarding the "molecular autopsy," which would include a postmortem genetic analysis aimed at detecting cardiac channel abnormalities in any child with sudden cardiac death. This currently is primarily a research tool, but could provide valuable information to survivors.

As to secondary prevention of sudden death following an episode of cardiac arrest, the authors of the statement acknowledged that identification, treatment, and appropriate activity restriction ca n't be successful in every case.

They therefore recommended extensive placement of automated external defibrillators in schools, along with cardiopulmonary resuscitation training of staff and others.

The statement also argued in favor of the establishment of a central registry for pediatric sudden cardiac arrest.

Other groups that have endorsed the statement include the American Heart Association, the American College of Cardiology, and the Heart Rhythm Society.

One of the authors of the statement disclosed receiving fees, honoraria, and royalties from Biotronik, Boston Scientific, Medtronic, St. Jude Medical, and Transgenomic.

After girl's death, mother strives for school CPR training

Joins effort to enact lifesaving legislation

By Henry L. Davis

NEWS MEDICAL REPORTER

Published:March 25, 2012, 10:27 PM

Updated: March 26, 2012, 7:38 AM

Would more timely CPR have saved Emily Adamczak's life as she lay on a soccer field in Akron?

That question lingered so much for her mother, Annette, that she became a vocal advocate for CPR training in schools after Emily's death from cardiac arrest in 2009.

She helped push Akron High School, where Emily was a freshman, to train the entire student body earlier this year in basic cardiopulmonary resuscitation during physical-education classes.

Now she has joined a statewide lobbying campaign for legislation to mandate CPR training, as well as instruction in the use of automated external defibrillators, or AEDs, in high schools across New York.

"We teach kids about safe sex and how to be a good parent, but we're not giving them lifesaving skills," Adamczak said.

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Currently, New York education law allows CPR instruction to be offered in high school health classes but doesn't require it.

A bill in the State Legislature that would mandate such training is sponsored in the Assembly by Harvey Weisenberg, D-Long Beach, and in the Senate by James S. Alesi, R-Perinton. The legislation, which has failed to move forward to a vote in the past, is in the Education committees in both houses.

Adamczak and others backing the bill say that CPR has changed and that it is easier to perform and teach today.

The purpose of CPR is to circulate oxygenated blood -- not to start the heart -- and keep the brain and other organs alive long enough until defibrillation and other advanced care can be performed to restore a normal heartbeat.

Nearly 300,000 out-of-hospital cardiac arrests occur annually in the United States. Survival rates vary widely by region, but the overall average is less than 8 percent.

In 2010, the American Heart Association revised its CPR guidelines. It recommended that untrained bystanders start chest compressions, instead of first clearing the airway and then performing mouth-to- mouth breathing, until an automated external defibrillator arrives to deliver a shock to the heart.

The organization made the change as a result of growing concern that bystanders were reluctant to get trained and perform the old CPR approach for a number of reasons, such as their own panic in such situations and anxiety over potentially harming a person, and apprehension about disease transmission and doing the procedure incorrectly.

Fewer than 1 in 3 victims of a cardiac arrest outside of a hospital receives lifesaving help from a bystander, according to several studies. However, nearly half of cardiac arrests are witnessed by someone, suggesting that more widespread training in CPR c ould improve the chances that bystanders will take action.

Still other studies show that more people are likely to do CPR if it involves only chest compressions and that more people are likely to take action if they have received training in CPR. Research also indicates that the simpler chest-only CPR significantly increases the willingness of bystanders to quickly perform CPR and, as a result, greatly improves survival rates.

"You can double or triple survival rates for the little time and cost it takes to train people," said Julianne Hart, state director of advocacy for the American Heart Association.

& nbsp;

Three states -- Alabama, Iowa and Rhode Island -- mandate CPR training in schools, according to the American Heart Association.

A key rationale behind efforts to make it a high school health class requirement is that the more people who know CPR and are comfortable using it, the more likely it is that survival rates will continue to improve, Hart said.

Opposition to requiring training centers on the cost to schools and the time that would be required. It's considered an unfunded mandate at a time when school budgets are being cut and the curriculum is jampacked. "CPR is an important issue, and this is a laudab le goal, but we oppose a mandatory requirement," said David Albert, spokesman for the New York State School Boards Association.

"Local districts should have the option of offering the training, as they do now, and the curriculum should not be mandated by the Legislature," he said. "There have been many bills over the years to mandate courses for various things. Many are laudable. But there is only so much time in the school day."

In response to opposition, Hart said that hands-only CPR can be taught in about 30 minutes and that training equipment is not expensive. Some CPR training kits cost less than $30 and can be reused.

She also said the bill requires only that students learn basic CPR skills and does not mandate certification in CPR, which involves a four-hour course taught by a certified instructor.

For advocates such as Adamczak, CPR would be a reasonable addition to the high school health class curriculum.

Her daughter, Emily, was a 14-year-old freshman when she suffered cardiac arrest while playing soccer in an in-house recreation program at the Akron Falls Park Sports Complex. Emily was active in sports, including soccer, swimming and track, but also suffered from a heart condition and was under a doctor's care.

Five minutes elapsed before a bystander who knew CPR got to Emily, vastly reducing her odds of survival.

"That was too long," Adamczak said. "If we had started CPR or gotten an AED to her more quickly, it might have been a different outcome."