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Pediatricians can play key role in preventing, responding to sudden cardiac arrest in children

April 1, 2024

The on-field sudden cardiac arrest (SCA) of Damar Hamlin during a televised professional football game in January 2023 renewed public attention to SCA during sports participation.

SCA is a leading cause of death in student athletes in the United States (Harmon et. al. Br J Sports Med. 2014;48:1185-1192).

Hamlin’s SCA highlighted important aspects of prevention and readiness that are key pillars of AAP recommendations outlined in the policy statement Sudden Death in the Young: Information for the Primary Care Provider. These strategies include the preparticipation physical exam (PPE), the development of emergency action plans (EAPs) with CPR training, and access to automated external defibrillators (AEDs).

AAP members can have a substantial impact on individual patients and their community by addressing these areas.

Preparticipation exam

The AAP recommends a PPE prior to sports participation every two to three years, with an annual, updated, interval history.

One of the goals of the PPE is to evaluate for conditions that may be life-threatening, including cardiac conditions. The family and individual history portion of the PPE is important for identifying cardiac conditions. A history of syncope or chest pain with exercise or family history of sudden death before age 50 should be evaluated further. The addition of an electrocardiogram to the PPE may increase the ability to detect many, but not all, cardiac conditions.

The AAP recommends that additional screening beyond the PPE should be at the discretion of the examining physician. In addition, it recommends screening all children for any risk factors for SCA using a four-question history at annual health maintenance visits.

Flowchart showing the role of the primary care provider in preventing SCD.

Preparing for SCA events

Helping organizations prepare for a possible event is another important step.

Because pediatricians are a trusted source of child health information, they can educate the public on how to recognize SCA. For example, athletes may collapse, lose consciousness or shake like they are having a seizure. Pediatricians also can raise awareness of the importance of training school and athletic personnel to recognize and respond to SCA.

Organizations should have a written EAP that details the steps to take after SCA and the team of personnel involved. Regularly rehearsing the EAP is critical, as the Hamlin episode demonstrated.

CPR training is an important component of any EAP, since early institution of high-quality CPR is important for maximizing clinical outcomes after SCA. This training also may include how to use an AED, if one is available.

Certified athletic trainers who have specialized training and expertise in maintaining the overall health and wellness of their student athletes are an important link in the chain of survival after SCA.

Legislative advocacy

The Hamlin event also resulted in renewed efforts to require AEDs in the public schools, highlighting the third way in which pediatricians can have an impact.

An estimated one in 25 U.S. schools may have an SCA event in any given year (Drezner JA, et al. Circulation. 2009;120:518-525). Research has shown that the survival rate after SCA in a school with an AED is seven times higher than the national average. Yet prior to the Hamlin episode, fewer than 20 states had legislation mandating an AED in every public school, and of those, only nine provided funding to support the mandate (Sherrid MV, et al. J Am Coll Cardiol. 2017;69:1735-1743).

Progress was made last fall, with four additional states enacting school AED legislation. Pediatricians can support local and national legislative efforts to get AEDs into schools, along with the commensurate funding and training.

SCA is a topic pediatricians are well-equipped to address, both on an individual and community basis. Education on how to prevent and respond to SCA in children can help maximize clinical outcomes.

Dr. Kinsella and Dr. Master are members of the AAP Council on Sports Medicine and Fitness Executive Committee.

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