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Sunday, June 5, 2011

Why young folks die from cardiac arrest

Here's an article written by Mehmet Oz and Mike Roizen. It's well-written, it mentions the most important points, but stops short of getting to the tragedy of it all, and it doesn't provide a solution.

They focus on HCM, a congenital disorder that yields a thicker left ventricle wall. In times of high demand on the heart (high exercise combined with high emotion (ever read about the basketball player that made the game-winning shot just before the buzzer and then died?) the heart can't supply the blood flow needed, and the person dies. Not to be macabre, but you can see this happen at SLICC's web site: Miki, who was 24 at the time of his death, was in the middle of a professional soccer / football match when his heart stopped. He put his head down - assumedly because he felt light-headed - and then collapsed. He didn't make it - which won't surprise you if you look closely at the quality of the CPR he got in the video.

But that's not the only reason young people die during sports. There are congenital problems with the heart's electrical circuitry such as WPW and long QT syndromes. Furthermore, there are fatal conditions (such as Comotio Cordis) that can be triggered by a sudden blow to the chest during a short but critical part of the heart's natural rhythm. This is most often seen when a lacrosse player is struck on the chest with a high-speed lacrosse ball.

So why don't we screen people for these conditions? Good idea, and in fact, Holly Morrell spends her time raising money to pay for screening for numerous conditions that might cause sudden cardiac arrest, but here is no underlying defect that permits Comotio Cordis to happen, because Comotio Cordis doesn't happen because of an underlying defect.

Here is the tragedy:
- To spot HCM - the hypertrophic cardiomyopathy referred to in the article below, you need to perform an echo cardiogram, and a cardiologist has to read it. Even then, it's not a really clear-cut test in some cases, and it's expensive.
- You can spot most electrical defects with an EKG, and a cardiologist will have to review that, too.
- You can have genetic screening performed for only $2,400 per person, but it's sensitivity is only 50% or so. That means it only picks up half the people you are looking for.
- You can reduce the cost of the screening by beginning with a smaller population, for example all 7th through 12th graders, and you can begin by administering a questionnaire designed to uncover family history that might predispose a child to an elevated risk of having one of these conditions. Any child that comes from a family with a suggestive history would then be screened by one of the more expensive methods.

Making some assumptions about the cost and efficacy of the various approaches, a rough estimate is that we could prevent about half the deaths from these causes. with a program that screened all athletes from 7th through 12th grade the first year and all 7th grade students thereafter. In Chatham County, Georgia, that would cost $30,000,000 the first year and $5,000,000 every year thereafter. Or perhaps the existing 7th through 12th population could be brought into the program over a period of six years. That would cost $10,000,000 every year for the first six years and $5,000,000 every year thereafter. To approximate the cost throughout the U.S.A. multiply those numbers by 1,000. It doesn't matter whether these cost estimates are high by a factor of ten - and I don't believe they are: this funding is not available.

There is a way, however, to prevent two-thirds of not only these defect-related and two-thirds of all the Comotio Cordis deaths: have everybody who plays or coaches or referees sports where these deaths might happen be trained in Bystander CPR and to have an AED at every practice and game. The cost can be negligible. Bystander CPR can be taught in a regular class session, and a suitable course is available at a minimal charge.

Now, here's the article that triggered my rant.

Bystanders Save 56-Year-Old Man's Life After Heart Attack

Phil Gaudreau
Sunday, June 5, 2011

Ottawa Paramedics are crediting a bystander's excellent CPR skills for saving a life in the Cumberland area on Sunday.

The 56-year-old man collapsed in his garage in the Frank Kenny Road area around 2:45 p.m..

Two women who saw him fall rushed over and began giving CPR.

Paramedics arrived on scene and rushed him to hospital where he's recovering.

They're reminding you that free CPR courses are available through the City, and more information in on the City's website.

2,000 learn to save lives in Viera

Operation CPR offers rescue basics

VIERA — Iveth Nunez works at the Veterans Affairs Outpatient Clinic, where she is required to be certified in cardiopulmonary resuscitation and sees the benefits of the life-saving technique.

Nunez covered the bases in CPR basics with her family Saturday morning near her workplace, joining a crowd of about 2,000 people on the outfield of Space Coast Stadium for Health First's "Operation Civilians Prepared to Respond."

Operation CPR offered a short, effective and free session in CPR and the use of an automated external defibrillator, AED. Nunez said she couldn't pass up the chance to get such training for her 13-year-old daughter, Shailine, and Nunez's two nephews, Eric Gibbons, 9, and Maurice Gibbons, 15.

"My daughter is at home with me when I'm baybsitting and I wanted her and my nephews to know what to do in case of an emergency," said Nunez, a medical support assistant.

"I have to stay up-to-date in training and I know how important this is."

Health First's third-annual CPR training event shared new guidelines that make the breaths-and-compression technique easier than it's ever been, the crowd was told.

While the event was intended to educate residents on how to perform CPR, official certification can be obtained through courses offered by Health First and the American Red Cross.

But those gathered took matters seriously, despite '70s disco music that attendees were advised to keep in mind as they did compressions and the rampant jokes about being surrounded by dummies.

Health First volunteers assisted attendees, from school and church groups to large and small families and individuals, throughout the training.

Just three years ago, the first session drew about 125 people.

Mike Means, Health First president and CEO, told Saturday's huge crowd they are a "tremendous help in Health First's mission to make Brevard County a healthy, safer and better place to live and work and raise a family."

Hundreds of families, who received money-saving coupons, Brevard Manatees tickets and T-shirts for attending, agreed. As "Stayin' Alive" played over the speaker system, Chris and Tami Fung of Viera took seats beside adult-size and baby-size CPR dummies.

The Fungs, who are members of the Health First gym, learned about the training through e-mail and thought it would be good for the entire family. So they brought their children, Katelyn, 4, and Connor, 2, along for the hour's worth of activity and instruction.

As Chris Fung placed his hands on a dummy to practice compressions, Katelyn crouched in front of him and put her small hands on the dummy's chest, too.

A volunteer watched, saying, "Good job," as dad and daughter worked together.

"We want the children to know to call 9-1-1 if there's an emergency and be able to help someone if we can, too," Tami Fung said.

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