Sudden cardiac death claims the lives of more NCAA athletes than any other sport-related trauma. So the NCAA Sport Science Institute and leading sports medicine groups across the country have crafted an interassociation statement on cardiovascular care in hopes of keeping athletes safer.
The statement was spurred by a two-day summit in September 2014 in Indianapolis that brought together more than two dozen experts who represented a bevy of top medical organizations, including the National Athletic Trainers’ Association, American Medical Society for Sports Medicine, American College of Cardiology and American Heart Association, among others.
Those discussions, combined with work accomplished in the year since the gathering, led to recommendations for both preventing and reacting to cardiac arrest among student-athletes, while also broadening the scope of cardiovascular care. Among these potentially life-saving protocols are seven important takeaways:
Physicals are critical. Pre-participation exams should be carried out for all college athletes before they are cleared to participate in sports, and, ideally, the exam should include an assessment of cardiac risk factors. The exam should include one of two standardized protocols: either the American Heart Association’s 14-point exam or the pre-participation physical examination monograph, fourth edition, an examination created by a group of top medical organizations. The process for administering these exams, which include questions regarding personal and family medical history and a physical exam, should be formalized in writing. Whenever possible, the exams should be performed on campus under the supervision of the school’s medical director. If it must be done off campus, the evaluations should follow the same standardized protocols and results should be reviewed by sports medicine personnel. Records pertinent to that screening should be kept on file throughout a student-athlete’s career.
Technology is not the solution, for now. Electrocardiograms are not required in preseason screenings, but they can detect some potentially lethal cardiac conditions when the results are interpreted by physicians with the appropriate training. That said, there remain incomplete knowledge and infrastructure support for an EKG to be considered a universal screening tool. For schools that use an EKG as part of the screening protocol, several considerations should be taken into account: a cardiovascular specialist who is capable of interpreting results should be identified; student-athletes should be given rationale for why they are undergoing EKG screening; and a plan of action for next steps should be outlined before any abnormalities are detected. Schools that use EKGs should include it as part of a screening protocol, not as a replacement for standardized questions about medical history and a physical examination.
Trust the experts. If abnormal results trigger the need for secondary testing, which is often more comprehensive and potentially invasive, it should be carried out either by or in consultation with skilled cardiovascular specialists. They are equipped to detect the differences between normal changes in student-athletes’ hearts due to the nature of their training and actual abnormalities that could cause problems.
Prepare for the worst. All NCAA schools should have an established action plan to respond to a college athlete who suffers cardiac arrest. The plan should be well-rehearsed – practiced annually, at least – because a fast response is critical: Data show roughly 90 percent of college athletes can survive a cardiac event if a defibrillator is used promptly. Action plans should include thoroughly training responders in CPR and automated external defibrillator use; establishing an effective emergency communication system; and creating different protocols for various game or practice environments across all sports.
Check the equipment. AEDs should be easily accessible in all locations used for athletics, including any areas used for strength training or conditioning as well as all gymnasiums and playing fields. The AEDs should be charged and function properly, and each device should have a checklist that indicates when it was last checked and by whom. This duty should be assigned, and the check should occur at least monthly.
Form partnerships. Before the academic year, plans should be put in place to integrate actions taken by onsite responders and local EMS personnel. Given that, an entry and exit point for emergency response vehicles should be established for practices as well as for games where a high volume of people and vehicles could impede a quick response and cost valuable seconds.
Know the signs. Deep gasping can occur within minutes of cardiac arrest and shouldn’t be misinterpreted as labored breathing. Eventually, those suffering cardiac arrest will collapse and roughly half will have involuntary arm and leg movements, which can easily be mistaken for a seizure. When a student-athlete is unresponsive, first responders should: call for help, and have someone contact emergency medical services; begin chest compressions and CPR; retrieve and use an AED as soon as possible; and clear access for EMS personnel.