Cardiopulmonary Resuscitation (CPR) and Automated External Defibrillator (AED) Education Victoria L. Vetter, MD, MPH, Youth Heart Watch Medical Director Danielle Haley, MPH, Youth Heart Watch Coordinator

Sudden Cardiac Arrest (SCA) A condition in which the heartbeat stops abruptly and unexpectedly. The instantaneous loss of electrical heart function. Usually caused by ventricular fibrillation (VF) An abnormality in the heart's electrical system which causes the heart to quiver and blood flow to the body and brain to stop. Everyone stands up front for introduction Alison Tells story after I introduce Mention Project ADAM Florida

What Causes Sudden Cardiac Arrest? An abnormality in the heart, either in the electrical system or in the heart’s structure or function. Over half to three quarters of the time, the abnormality is not diagnosed prior to the arrest and SCA is the first symptom. Many of these conditions are inherited, so it is important for family members to be aware of their family history.

What Conditions Cause SCA? The most common categories include Congenital Heart Disease Abnormal Heart Structure Cardiomyopathies Abnormal Heart Function Primary Electrical Disease Abnormal Heart Rhythm

What Conditions Cause SCA? Coronary Artery Anomalies Acquired Heart Disease Myocarditis (heart infection) Drugs Commotio Cordis (blow to chest)

Symptoms of Sudden Cardiac Arrest Warning signs and symptoms Fainting with exercise Rapid heart or irregular heart beats (palpitations) with exercise Chest pain with exercise Shortness of breath with exercise (not related to asthma) Extreme or unexpected fatigue

Risk Factors for Sudden Cardiac Arrest Family history of known heart abnormalities or sudden death before age 50 years Family history of Long QT Syndrome, Brugada Syndrome, Hypertrophic Cardiomyopathy, Arrhythmogenic Right Ventricular Dysplasia or other Congenital Heart Disease Family members with unexplained fainting or seizures Use of drugs such as cocaine, inhalants, “recreational” or club drugs

Lesions Associated with Sudden Cardiac Arrest Cardiomyopathy (CM) Hypertrophic (HCM) Dilated CM (DCM) Right ventricular CM (ARVC) Primary Electrical Disease Long and Short QT Syndromes Brugada syndrome Ventricular tachycardia Primary ventricular fibrillation Wolff-Parkinson-White (WPW) Congenital Heart Disease (CHD) Coronary Artery Anomalies Acquired Heart Disease Myocarditis Drugs Marfan Syndrome Commotio Cordis Parent Heart Watch Database

How Common Are The Conditions That Cause SCA? Hypertrophic Cardiomyopathy 1/500 Other Cardiomyopathies/Myocarditis 1/1000 Long QT Syndrome 1/2000 Wolff-Parkinson-White (WPW) 1-3/1000 Brugada Syndrome 1-3/10,000 Other Primary Electrical Conditions 1/1000 Coronary Artery Anomalies 1-3/1000 Total ~ 4-6/1000

Hypertrophic Cardiomyopathy Diagnosis Thickened ventricular septum on echocardiogram or MRI Abnormal electrocardiogram Enlarged heart Gene mutations -MYH7, MYBPC3...

Long QT Syndrome Characteristics Prolonged QT Interval Synope/Fainting/Seizures Malignant Ventricular Arrhythmias Torsades de Pointes Sudden Death QTc = 580 ms

Coronary Artery Abnormalities Right or Left Coronary Artery from wrong/opposite Coronary Cusp. Causes 10-20% of sudden death in athletes. During exercise, ventricular fibrillation occurs.

Who Is At Risk for Sudden Cardiac Arrest? Athletes General & Selected Child and Adolescent Population Known congenital heart disease Undiagnosed cardiac conditions Exposure to drugs, medications, toxins, infectious agents Infants or Neonates

How to Recognize and Prevent SCA When SCA occurs, the heart stops beating and doesn’t pump blood to the body. The person suddenly passes out, and appears lifeless—except for abnormal “gasping” or seizure-like movements. The SCA victim is unconscious and needs immediate help. If nothing is done, the victim will die within minutes.

Problems with Identification of Conditions that Cause SCA There is a relatively low frequency of these conditions in the population. The conditions that cause SCA may not be apparent on routine physical exam. Symptoms may not be present prior to the SCA. ECG/ECHO Findings: It may be difficult to distinguish true disease from athlete’s heart due to training.

The Problem… 20% of our population can be found on a school campus on any given day. 420,000 Americans die each year from SCA, including more than 2,000 children. Every minute of delay following SCA decreases the chance of survival by 10%.

…Why the Solution is CPR and AED Education in Schools Broad deployment of AEDs and increased bystander CPR could prevent as many as 50,000 deaths each year. AEDs can be safely placed in schools. The best chance of SCA survival is prompt recognition, and a planned emergency response. .

Sudden Cardiac Arrest Prevention What is Primary Prevention for SCA? Any method to prevent sudden cardiac arrest from occurring in order to reduce sudden cardiac death, usually by identification of a predisposing condition and early intervention. Optimize Screening Identify and Treat High-Risk Children Medication Lifestyle alterations Implantable Cardioverter Defibrillator (ICD)

Sudden Cardiac Arrest Prevention What is Secondary Prevention for SCA? Any methods to prevent sudden cardiac death from occurring once someone has experienced a sudden cardiac arrest. Cardiopulmonary Resuscitation (CPR) Automated External Defibrillator (AED) Implantable Cardioverter Defibrillator (ICD) 

Chain of Survival The chain of survival refers to five events that must occur quickly to optimize a person's chance of surviving a cardiac arrest. The five links of the chain: Immediate recognition of cardiac arrest and activation of the emergency response system. Early CPR with emphasis on chest compressions. Rapid defibrillation to establish a normal heart rhythm to a person suffering a cardiac arrest. It is most effective when it is performed in the first few minutes of a cardiac arrest. Effective advanced life support. Integrated post-cardiac arrest care.

How to Recognize and Prevent SCA When SCA occurs, the heart stops beating and doesn’t pump blood to the body. The person suddenly passes out, and appears lifeless—except for abnormal “gasping” or seizure-like movements. The SCA victim is unconscious and needs immediate help. If nothing is done, the victim will die within minutes.

If the Victim is Unresponsive The first responder should call 9-1-1 and start CPR immediately. Someone else should get the AED. Don’t wait for a responder to ask for it. If you see someone collapse suddenly, make sure someone gets the AED, even if you don’t know what has happened. Know that time is essential, and this requires a rapid response from everyone involved. Seconds count. One person should stay near the front door to direct EMS responders to the scene.

How to Perform Hands-Only CPR If you see a person suddenly collapse, just remember these two easy steps: Call 9-1-1 Push hard and fast on the center of the chest

How to use an Automated External Defibrillator Verify the victim is unconscious or without signs of circulation. Turn on AED and attach electrodes. The AED ANALYZES the heart rhythm. Follow the voice prompts and screen messages.

How You Can Save a Life Survival from SCA requires immediate intervention, frequently by bystanders like you. Prompt treatment could save 40-80% of those experiencing SCA. An increase in the current survival rate to only 20% would save 50,000 lives each year.

For more information about CPR/AED programs, education and training, contact Youth Heart Watch Phone: 267-426-7389 E-mail: youthheartwatch@email.chop.edu