Post on 17-Dec-2015
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
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
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