1. 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

2. 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

3. 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.

4. 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

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

6. 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

7. 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

8. 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

9. 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 /10,000
Other Primary Electrical Conditions 1/1000
Coronary Artery Anomalies 1-3/1000
Total ~ 4-6/1000

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

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

12. 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.

13. 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

14. 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.

15. 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.

16. 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%.

17. …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. .

18. 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)

19. 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) 

20. 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.

21. 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.

22. If the Victim is Unresponsive
The first responder should call 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.

23. 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

24. 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.

25. 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.

26. For more information about CPR/AED programs, education and training, contact Youth Heart Watch Phone: