Cardiac Arrest Due to an Anomalous Coronary Artery in an Adolescent Athletic Male: Should We Be Teaching CPR in High School?

Introduction: Sudden Cardiac Death (SCD) is a global health issue with out-of-hospital cardiac (OHCA) arrest being the third leading cause of death in developed nations. Initiation of cardiopulmonary resuscitation (CPR) by bystanders improves survival and neurologic function. This is a case report of a 14-year-old athletic male presenting with sudden cardiac arrest secondary to an anomalous coronary artery with good neurological outcome after early bystander CPR. Case Description: A 14-year-old male presented with cardiac arrest while playing basketball. His friends initiated and performed CPR for approximately 10 minutes until EMS arrived. His initial rhythm was Ventricular Fibrillation. He was intubated and defibrillated with return of spontaneous circulation. A trans-thoracic echocardiogram on amiodarone, milrinone and epinephrine infusions was suspicious for an anomalous origin of the left coronary artery. A Cardiac CT scan with angiography confirmed an aberrant course of his left main coronary artery (LCMA) from the right coronary cusp. His cardiac function improved, inotropes were weaned, and antiarrhythmics were transitioned. He underwent reimplantation of his anomalous left coronary artery and had an uncomplicated postoperative course. He was neurologically intact at discharge. Discussion: LMCA arising from the right sinus of Valsalva is rare with a prevalence of 0.1 to 0.3 percent and typically presents as myocardial ischemia, ventricular arrhythmias, and/or cardiac arrest. It is the second most common cause of OHCA in young athletes. Early bystander CPR is proven to improve survival rates in OHCA by at least 2 to 3 fold. Survival with intact neurological outcome is dependent on adequate perfusion to the brain with a delay of a few minutes making the difference between survival with intact neurological function versus survival with neurological injury. In children, survival to hospital discharge was 10.7% with only 8.2% with good neurologic function. Furthermore, bystander intervention in the U.S. remains low. Given the difficulty of teaching an entire population CPR, it is sensible to introduce and integrate CPR into educational programs as it is low-cost, easy to teach, and effective. Similar programs encouraging driving safely exist in most school curricula. In 2018, the American Academy of Pediatrics endorsed life-support training in the article titled, "Advocating for Life Support Training of Children, Parents, Caregivers, School Personnel and the Public". Currently 38 states in the U.S. have mandated or adopted a curriculum requiring CPR training for students in order to graduate high school. Conclusion: Bystander CPR rates in the U.S. continue to remain low despite a high prevalence of sudden cardiac death. Focused efforts such as providing CPR training for OHCA to high school students can lead to a higher survival rate with improved neurological outcomes in children and adults.