Sudden Cardiac Death How 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 Channelopathy Commotio Cordis Wolf-Parkinson White Syndrome Valvular Heart Disease Electrocution Drugs Sudden Infant Death 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 # Deaths per million/yr Age (yrs)

Causes of SCD under 50 years Age (yrs) # Deaths per million/yr

What can you do about it ? 1.Prevention through screening 2.Prompt defibrillation

Screening 1.Principles 1.Practical 2.Reliable 3.High sensitivity and specificity 4.Cost effective

Screening 2. Questionnaire 1.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 Tests 1.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 19881% Seattle % (First responder programme) Las Vegas % (overall) 72% (3 mins) Ireland 2003 ~ 1% 80% of cardiac arrests occur at home 70% of cardiac arrests are witnessed

The Problem How do we get AEDs to cardiac arrest victims within 5 minutes of collapse ? Possible strategies; 1. Increase density of ambulance dispatch centres 2. Police cars 3. Public Access Defibrillation Sports venues / clubs All airplanes Shopping Centres Gyms Golf Clubs Jails 4. First Responder programmes

Ambulance Dispatch Centres 7710

The Problem How do we get AEDs to cardiac arrest victims within 5 minutes of collapse ? Possible strategies; 1. Increase density of ambulance dispatch centres 2. Police cars 3. Public Access Defibrillation Sports venues / clubs All airplanes Shopping Centres Gyms Golf Clubs Jails 4. First Responder programmes

Progetto Vita in Piacenza, Italy, % (16.6%) 11.1% (43.7%) P<0.05 Conventional EMS Progetto Vita The first experience of out-of-hospital early defibrillation by non-medical volunteers in a medium-size European city. 39 semiautomatic external defibrillators 266,531 inhabitants 12 high-risk locations, 12 lay-staffed ambulances 15 police-cars lay volunteers trained to intervene 197 Cardiac arrests % Survival Total (Shockable Rhythms)

The Problem How do we get AEDs to cardiac arrest victims within 5 minutes of collapse ? Possible strategies; 1. Increase density of ambulance dispatch centres 2. Police cars 3. 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