Study Highlights

• Emergency Preparedness
  • A written and structured emergency action plan is recommended for every school or institution that sponsors athletic events.
  • The emergency action plan should be developed with EMS personnel, school officials, first responders, and administrators.
  • The emergency action plan and equipment should be reviewed and practiced annually, and targeted first responders should be trained in CPR and AED use.
  • Emergency equipment should be at the site with quick access available, and personnel should be trained to use it.
  • AEDs placed at public locations can substantially improve survival from sudden cardiac arrest, and athletic venues should have them placed at prominent locations.
  • The emergency action plan should target a collapse-to-EMS call time and CPR initiation of less than 1 minute.
  • A target goal of less than 3 to 5 minutes from time of collapse to first shock by AED is strongly recommended.
  • Review of equipment readiness and the emergency action plan by on-site personnel for each event is desirable.
• Management of Sudden Cardiac Arrest
  • In 55% to 80% of cases of sudden cardiac arrest, the athlete is asymptomatic until the cardiac arrest.
  • Initial components of sudden cardiac arrest management are early activation of EMS, early CPR, early defibrillation, and rapid transition to advanced life support.
  • Sudden cardiac arrest should be suspected for any collapsed and unresponsive athlete.
  • Young athletes who collapse after a blow to the chest by a firm projectile or by player contact should be suspected of sudden cardiac arrest from commotio cordis.
  • 1 or more trained rescuers should begin CPR while another alerts the EMS system by calling 911 (in the United States) and retrieving the AED.
  • The rescuer should open the airway using the "head tilt–chin left" maneuver and then look, listen, and feel.
  • If normal breathing is not detected within 10 seconds, 2 rescue breaths should be given followed by chest compressions.
  • An AED should be applied as soon as possible on any collapsed and unresponsive athlete for rhythm analysis and defibrillation if indicated.
  • New American Heart Association guidelines eliminate lay rescuer assessment of pulse and recommend that cardiac arrest be assumed if the unresponsive person does not demonstrate normal breathing.
  • A healthcare provider may feel for a pulse and initiate CPR if a pulse is not felt within 10 seconds.
  • CPR should be provided while awaiting the AED, and early bystander CPR can double or triple the chance of survival from ventricular fibrillation sudden cardiac arrest.
  • A universal compression-to-ventilation ratio of 30:2 is recommended for single rescuers and all sudden cardiac arrest cases.
  • Chest compressions ("push hard, push fast") should be at the rate of 100 per minute, allowing complete chest recoil and minimizing interruptions in compression.
  • CPR should resume immediately after initial shock, beginning with chest compressions.
  • For EMS personnel, 5 cycles (or 2 minutes) of CPR should be provided before defibrillation for witnessed arrest.
  • CPR should be continued until advanced life-support providers take over or the person starts to move.
  • Rescuers should be trained to recognize sudden cardiac arrest.
  • Rapid access to the person experiencing sudden cardiac arrest should be given to EMS personnel.

Pearls for Practice

• Comprehensive emergency planning is recommended for high school and college athletic events and venues, including trained personnel and a target response time of 1 minute to CPR and 3 to 5 minutes to first shock by AED.
• Sudden cardiac arrest should be suspected in any high school or college athlete who collapses and is unresponsive, and the updated American Heart Association guidelines should be followed for CPR and AED initiation.