While sudden cardiac events in young athletes are startling to hear about, they aren’t a new occurrence.
Sudden cardiac arrest in young athletes has a 1 in 50,000 chance of happening.
“When we say cardiac arrest, it usually means that they are in a rhythm called ventricular fibrillation or ventricular tachycardia that is not compatible with life, and the only way to restore normal rhythm is electrically,” said Dr. Judith Mackall, Director of the Center for Cardiovascular Genetics at University Hospitals Harrington Heart & Vascular Institute.
Bronny James, the son of LeBron James, suffered a sudden cardiac arrest on Monday during a basketball practice at the University of Southern California.
He was released from the hospital Tuesday and is recovering at home after being treated at the scene by athletic medical staff, according to multiple reports.
Immediate online speculation from the public, including Twitter CEO Elon Musk, has prompted the idea that sudden cardiac arrest could be linked to the COVID-19 vaccines. However, there has not been a change in the frequency of sudden death events post-pandemic, said Dr. Robert Flannery, a University Hospitals primary care sports medicine physician and assistant team physician for the Cleveland Browns.
“Obviously some of those numbers are still being compiled as we are still fairly close to it. But we haven’t really seen an uptick in cardiac arrest,” Flannery said. “These things have been happening for a long time. We’ve had a couple of very high-profile ones in the past couple of months, and [that] certainly brings it to the forefront. But you can go back to [February 2020] and Jay Bouwmeester collapsing on the bench at a hockey game; Chris Pronger taking a puck to the chest in the late ‘90s, all the way back to Hank Gathers in the ‘80s sustaining sudden cardiac arrest (in college basketball). These things happen, we know that they happen. We want to be prepared when they happen, and that's going to be the most important thing to come out of this.”
The 18-year-old James’ episode is the second high-profile cardiac arrest this year after Buffalo Bills player Damar Hamlin suffered commotio cortis (caused by a blow to the chest) during a live televised NFL game in January.
Causes of Sudden Cardiac Arrest
It could happen for a number of reasons — the most common being a condition called hypertrophic cardiomyopathy, in which the heart muscle becomes thickened and pumping blood is more difficult.
Sometimes it’s challenging to determine exactly what happened — and usually involves a thorough investigation. “You check out the plumbing. You check out the structure and the anatomy. You look at the muscle. Oftentimes MRI scans are very useful to determine that,” Mackall said.
Many states, including Ohio, mandate a pre-participation physical for student-athletes during which tests can help identify potential warning signs for heart issues before cardiac arrests happen, though sometimes cardiac arrest can be the presenting symptom of an issue.
The Importance of an Emergency Action Plan
Without knowing the details of James’ case — Flannery said USC likely had a well-planned and effective Emergency Action Plan that helped save his life.
An Emergency Action Plan is a set of guidelines set by athletic professionals and their medical teams to help get the heart restarted. One of the goals is to make sure that an automated external defibrillator (AED) is within three minutes of every venue and can get there quickly. Hands-only cardiopulmonary resuscitation (CPR) is utilized in the meantime to keep blood pumping throughout the body.
Whether part of the athletic medical or training staff or not, Mackall and Flannery both shared that it is important to learn bystander CPR, as well as how to use an AED, in case a sudden cardiac arrest event happens near you. Both trainings are simple to learn and can be life-saving.
For every minute CPR is not administered after cardiac arrest, the chance of survival goes down by 10 percent, Flannery said. Mackall shared that the implementation of AEDs has increased the chance of survival to 35% to 40%.
Earlier this month, University Hospitals partnered with the Cleveland Browns cornerback Denzel Ward’s Make Them Know Your Name Foundation (MTKYN) and Kaulig Companies to launch the “AEDin3” program to get AEDs in more school athletic centers. The 60 schools UH is partnered with will be participating in a video “challenge” to test their ability to reach an AED within three minutes with recorded videos, and once completed, challenging other schools to do the same.
Flannery, who is directing the program, said, “We realize this is a very serious topic and not everyone has the same outcome as Damar Hamlin or … Bronny James. That said, we have seen other organizations do fun things to raise awareness, which is what we’re trying to do here.”
The Importance of Play
Mackall said that despite the recent attention on sudden cardiac arrests, it should not be a deterrent to athletics for those who have not been advised against playing due to heart issues.
“We have a lot of … people who participate in athletics and competitive athletics. I think that’s a great thing. That should be highly encouraged. I don't think you ever want to tell someone not to participate,” Mackall said. “Having a heart-healthy lifestyle involves regular aerobic exercise, and I think habits that you develop in childhood and carry on through adulthood are very important.”