Sudden Cardiac Death How common is it

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Sudden Cardiac DeathHow common is it ?

• Of the 728,743 heart disease deaths in 1999,
  462,340 (63.4) were defined as sudden cardiac
  deaths (SCD).
• These high numbers of sudden deaths from heart
  disease, and the fact that they occur outside of
  the hospital, are alarming,"
• Jeffrey P. Koplan, MD, MPH
• Director, Centre for Disease Control, Feb
  2002

In Ireland, this corresponds to some 6,000
sudden cardiac deaths annually
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What is sudden Cardiac Death ?

• Cardiac arrest
• A massive heart attack
• He just dropped dead
• He died in his sleep
• A massive stroke
• A huge clot to his heart
• Cot death
• Sudden Infant Death Syndrome (SIDS)
• Sudden Heart Failure
• Sudden Adult Death Syndrome (SADS)

• Death occurring within one hour of onset of
  symptoms due to cardiac causes

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Ventricular Tachycardia
Normal Rhythm
Ventricular Fibrillation
2 8 year old man who died suddenly while wearing
a cardiac monitor
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Hypertrophic Cardiomyopathy
Viral Myocarditis
Valvular Heart Disease
Dilated Cardiomyopathy
Drugs
Ventricular Fibrillation
Commotio Cordis
Channelopathy
Electrocution
Coronary Artery Disease
Sudden Infant Death Syndrome
Wolf-Parkinson White Syndrome
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Likelihood of success with defibrillation
Ventricular Tachycardia
Time from Collapse
Normal Rhythm
0 mins
gt90
2 mins
80
10 mins
lt10
2 8 year old man who died suddenly while wearing
a cardiac monitor
Ventricular Fibrillation
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Causes of SCD by age
Deaths per million/yr
Age (yrs)
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Causes of SCD under 50 years
Deaths per million/yr
Age (yrs)
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What can you do about it ?

• Prevention through screening
• Prompt defibrillation

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Screening

• Principles
• Practical
• Reliable
• High sensitivity and specificity
• Cost effective

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Screening

• 2. Questionnaire
• Do you have a first degree relative who dropped
  dead suddenly under 50 y.o. or who has been
  diagnosed with a heart condition ?
• Have you had a blackout for no obvious reason ?
• Have you had sudden onset rapid heart beating ?
• (Do you get chest tightness or shortness of
  breath out of the ordinary while exercising ?)
• If yes to any of above, refer to GP.
• If significant family history or symptoms, refer
  to local cardiologist for further testing

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Screening

• 3. Cardiac Tests
• Electrocardiogram
• Exercise Test (Steps or treadmill)
• Echocardiogram (Ultrasound)
• 24 hour Holter Monitor

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Problems with Screening

• Indeterminates / False positives
• False negatives
• Myocarditis / Commotio Cordis
• How often should they be repeated
• What to do with true positives

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Sir Rannulph Fiennes after completing 7 marathons
in 7 days on 7 continents
6 months after cardiac arrest and bypass surgery
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The Automatic External Defibrillator (AED)
The Solution to out of hospital Cardiac Arrest
is shocking
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Commotio Cordis 13 y.o boy hit with a baseball
in the chest and successfully resuscitated with
an AED by passing police officers
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Cardiac Arrest Survival Rates

• Chicago 1988 1
• Seattle 1998 24 (First responder programme)
• Las Vegas 1999 30 (overall)
• 72 (3 mins)
• Ireland 2003 1

80 of cardiac arrests occur at home
70 of cardiac arrests are witnessed
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The Problem

• How do we get AEDs to cardiac arrest
• victims within 5 minutes of collapse ?
• Possible strategies
• 1. Increase density of ambulance dispatch
  centres
• 2. Police cars
• 3. Public Access Defibrillation
• Sports venues / clubs All airplanes
• Shopping Centres Gyms
• Golf Clubs Jails
• 4. First Responder programmes

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Ambulance Dispatch Centres
77
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The Problem

• How do we get AEDs to cardiac arrest
• victims within 5 minutes of collapse ?
• Possible strategies
• 1. Increase density of ambulance dispatch
  centres
• 2. Police cars
• 3. Public Access Defibrillation
• Sports venues / clubs All airplanes
• Shopping Centres Gyms
• Golf Clubs Jails
• 4. First Responder programmes

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Progetto Vita in Piacenza, Italy, 1999
39 semiautomatic external defibrillators
12 high-risk locations, 12 lay-staffed
ambulances 15 police-cars.
Survival
12 10 8 6 4 2 0
1285 lay volunteers trained to intervene
11.1 (43.7)
The first experience of out-of-hospital early
defibrillation by non-medical volunteers in
a medium-size European city.
Total

(Shockable Rhythms)
2.9 (16.6)
Plt0.05
Conventional EMS
Progetto Vita
197 Cardiac arrests
266,531 inhabitants
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The Problem

• How do we get AEDs to cardiac arrest
• victims within 5 minutes of collapse ?
• Possible strategies
• 1. Increase density of ambulance dispatch
  centres
• 2. Police cars
• 3. Public Access Defibrillation
• Sports venues / clubs All airplanes
• Shopping Centres Gyms
• Golf Clubs Jails
• 4. First Responder programmes

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Community First Responder Scheme
Incoming Call
Control Centre Regional Operator
999
Nurse
Emergency Medical Technician
2 members of local community response team on
call carrying pager/mobile and AED
Ambulance
Physician
Fire Brigade
Police Station / Patrol Car
Trained Community Member
Victim
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What can the GAA do ?

• Adopt a policy supporting the widespread
  deployment of AEDs in clubs
• Encourage clubs to raise money locally to
  purchase an AED and train all / most coaches in
  their use (4 hr training course)
• AEDs cost 2,500.
• Could clubs become the location for a communitys
  AED ?

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What can coaches do ?

• Get trained and encourage colleagues to get
  trained in basic life support (BLS) AED
• Nearest training centre details available from
  The Irish Heart Foundation
• Know how to recognise cardiac arrest and teach
  others
• Have a response strategy for your club (AED / 999
  / CPR)
• Find secure but accessible location for AED in
  the club
• Task Force on Sudden Cardiac Death guidelines to
  be discussed with sporting groups and published
  in 2005

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Cormac Mac Anallen
The solution is shocking
Marc-Vivien Foe
Miklos Fehrer
John McCall