Monday, February 1, 2016

You Could Be the Hero!

by Larry Creswell, M.D.

A couple heart-warming news reports caught my eye this month and I thought I’d share the stories -- and lessons -- with you here.

The first news report came from St. Petersburg, Florida, the site of the Meek and Mighty Triathlon that was held in conjunction with the St. Anthony’s Triathlon weekend activities in early May. During the bike portion of the event, Teresa McCoy, 37 years old, encountered a couple police officers tending to a fellow rider who was lying on the ground. She thought to stop and see if she could help and recognized right away that the man was pulseless. Teresa began cardiopulmonary resuscitation (CPR) with one of the officers while the other ran to his patrol car to get an automatic external defibrillator (AED). They used the AED to administer one shock, restoring the athlete-patient’s heart rhythm and Teresa went on her way to finish the triathlon. She would learn later that the athlete was fortunate to survive.

The second news report came earlier this month from Starkville, Miss., home to Mississippi State University. The long-time coach of the Mississippi Bulldog track and field team, Al Schmidt, collapsed in cardiac arrest at the SEC Outdoor Track & Field Championships. He received CPR immediately from bystanders, received two shocks from an AED that was available, and survived to reach the hospital where his continued treatment included implantation of an internal defibrillator and coronary artery bypass surgery.

These stories are very special because the victims defied the odds -- thanks entirely to the efforts of bystanders. Sad to say, the survival rate for out-of-hospital cardiac arrest is less than 10% despite widespread education efforts and the availability of emergency medical services (EMS) in most communities.

Sudden Cardiac Death (SCD) in Athletes
Fortunately, sudden cardiac death (SCD) is an uncommon event, but we know too well the anecdotal stories of athletes who have died during practice or competition. These events often attract much attention in the popular press. For athletes younger than 30 years, the most common causes are hypertrophic cardiomyopathy (HCM) or an arrhythmia due to an inherited condition such as prolonged QT syndrome. For athletes older than 30 years, the most common cause is coronary artery disease (CAD) -- the build-up of atherosclerotic plaque in the coronary arteries. Regardless of the particular underlying cause, the athlete dies from a sudden arrhythmia (abnormal heartbeat) that originates in the pumping chambers of the heart.

The treatment of SCD is prompt defibrillation (application of a shock to the victim) to restore the normal heartbeat. Until that shock can be administered, CPR is useful to help maintain some degree of circulation to the body’s organs. The survival rate is dismal without immediate CPR and the chance for survival is virtually nil if the heart’s regular rhythm cannot be restored by defibrillation within a few minutes.

There is some encouraging news about the survival rate in recent years for athletes with SCD -- at least those in school-based programs. When school-age athletes (from middle school through college) are considered, the survival rate for SCD during school-sponsored events may be as high as 20%. This somewhat better outcome for school-based athletes is attributed, in large part, to the ready availability of coaches and other personnel who are trained in CPR and the ready availability of AEDs at event venues.

What Can You Do?

  1. Learn CPR and how to use an AED. We are safest when our group of fellow athletes knows how to perform bystander CPR and how to use an AED. The more of us who are trained, the safer we all will be as a group. A variety of classes is offered by the American Heart Association (AHA) in communities throughout this country. A directory of courses in your particular geographical location can be found in the CPR/ECC section at the AHA website at www.heart.org or by calling the AHA at 877-AHA-4CPR. The most appropriate class for athletes would be their Heartsaver AED offering.

  2. Be an advocate for CPR/AEDs in your community. Again, we’re all safer with more fellow athletes trained in CPR and more AEDs available in the places where we train and compete. Encourage your training partners, your coach(es), and your local triathlon (and cycling, running, and swimming) clubs to promote an interest in CPR training. The AHA can partner with such organizations to offer classes at convenient times and locations. Check at your gym, fitness center, or swimming pool to make certain that an AED is available -- and where it is located. If there isn’t an AED, encourage the management to make it a priority.

  3. Plan for safety. Lastly, many of the readers here will be involved in the management, direction, or promotion of local training opportunities and competition events in their communities. Take a leadership role in ensuring the safety of the participants by having adequate numbers of staff/volunteers who are trained in CPR and by having ready access to EMS or an AED at the event.

This is an area where you really can be the hero.


Larry Creswell, M.D., is a cardiac surgeon and Associate Professor of Surgery at the University of Mississippi Medical Center in Jackson, Mississippi. In addition to his regular column on Endurance Corner, he maintains the Athlete's Heart blog to offer information about athletes and heart disease in an informal way and to encourage exchange and discussion that will help athletes build a heart-healthier lifestyle. You can contact him at lcreswell@surgery.umsmed.edu.

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