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

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

2 8 year old man who died suddenly while wearing a cardiac monitor

Ventricular Tachycardia

Normal Rhythm

Ventricular Fibrillation

Ventricular

Fibrillation

Coronary

Artery

Disease

Dilated

Cardiomyopathy

Hypertrophic

Cardiomyopathy

Viral

Myocarditis

ChannelopathyCommotio

Cordis

Wolf-Parkinson

White Syndrome

ValvularHeartDisease

Electrocution

Drugs

Sudden InfantDeath Syndrome

0 mins

2 mins

10 mins

Time from Collapse Likelihood of success with defibrillation

>90%

80%

<10%

2 8 year old man who died suddenly while wearing a cardiac monitor

Ventricular Tachycardia

Normal Rhythm

Ventricular Fibrillation

Causes of SCD by age

0

500

1000

1500

2000

2500

0 10 20 30 40 50 60 70 80 90

CAD Cardiomyopathy Channelopathy

# D

eath

s pe

r m

illi

on/y

r

Age (yrs)

Causes of SCD under 50 years

0

50

100

150

200

250

300

350

400

450

500

0 10 20 30 40 50

CAD Cardiomyopathy ChannelopathyAge (yrs)

# D

eath

s pe

r m

illio

n/yr

What can you do about it ?

1. Prevention through screening

2. Prompt defibrillation

Screening

1. Principles1. Practical

2. Reliable

3. High sensitivity and specificity

4. Cost effective

Screening

2. Questionnaire1. Do you have a first degree relative who dropped

dead suddenly under 50 y.o. or who has been diagnosed with a heart condition ?

2. Have you had a blackout for no obvious reason ?3. Have you had sudden onset rapid heart beating ?4. (Do you get chest tightness or shortness of

breath out of the ordinary while exercising ?) 5. If yes to any of above, refer to GP.6. If significant family history or symptoms, refer to

local cardiologist for further testing

Screening

3. Cardiac Tests1. Electrocardiogram

2. Exercise Test (Steps or treadmill)

3. Echocardiogram (Ultrasound)

4. 24 hour Holter Monitor

Problems with Screening

1. Indeterminates / False positives

2. False negatives

3. Myocarditis / Commotio Cordis

4. How often should they be repeated

5. What to do with ‘true positives’

Sir Rannulph Fiennes after completing 7 marathons in 7 days on 7 continents…

…6 months after cardiac arrest and bypass surgery

The Automatic External Defibrillator (AED)

The Solution to out of hospital Cardiac Arrest is shocking

Commotio Cordis

13 y.o boy hit with a baseball in the chest

and successfully resuscitated with an

AED by passing police officers

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

The ProblemHow do we get AEDs to cardiac arrest victims within 5 minutes of collapse ?

Possible strategies; 1. Increase density of ambulance dispatch centres2. Police cars3. Public Access Defibrillation

• Sports venues / clubs • All airplanes• Shopping Centres • Gyms• Golf Clubs • Jails

4. First Responder programmes

Ambulance Dispatch Centres

77 10

The ProblemHow do we get AEDs to cardiac arrest victims within 5 minutes of collapse ?

Possible strategies; 1. Increase density of ambulance dispatch centres2. Police cars3. Public Access Defibrillation

• Sports venues / clubs • All airplanes• Shopping Centres • Gyms• Golf Clubs • Jails

4. First Responder programmes

Progetto Vita in Piacenza, Italy, 1999

2.9%(16.6%)

11.1%(43.7%)

P<0.05ConventionalEMS

Progetto Vita

The first experience of out-of-hospital early defibrillation by non-medical volunteers in amedium-size European city.

39 semiautomatic external defibrillators

266,531 inhabitants

12 high-risk locations, 12 lay-staffed ambulances 15 police-cars.

1285 lay volunteers trained to intervene

197 Cardiac arrests

12

10

8

6

4

2

0

%

Survival

Total(ShockableRhythms)

The ProblemHow do we get AEDs to cardiac arrest victims within 5 minutes of collapse ?

Possible strategies; 1. Increase density of ambulance dispatch centres2. Police cars3. Public Access Defibrillation

• Sports venues / clubs • All airplanes• Shopping Centres • Gyms• Golf Clubs • Jails

4. First Responder programmes

Community First Responder Scheme

Ambulance

Physician

Emergency Medical Technician

Police Station / Patrol Car

Trained Community Member

Fire Brigade

Incoming Call 999

Control Centre Regional Operator

2 members of local community response team on call carrying pager/mobile and AED

Victim

Nurse

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 community’s AED ?

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

Cormac Mac Anallen

Marc-Vivien Foe Miklos Fehrer

John McCall

The solution is shocking