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What is Sudden Cardiac Arrest?
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Sudden cardiac arrest is the leading cause of death among young athletes
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Athletes are considered the healthiest members of society, yet
catastrophic death can occur without warning signs.
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SCA causes a normal heart to an fibrillation called: Ventricular Fibrillation

After a few minutes of VF the vital organs do not get blood flow and will
die

The heart must receive a shock from an AED to reset the electrical system
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An AED and CPR can quadruple survival from SCA
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Community AED programs are the only way to insure immediate access to
life saving therapies
Every Minute Counts!
Commotio Cordis a cause of Sudden
Cardiac Death is caused by a blow to the
chest directly over the heart in between
beats, leading to sudden cardiac arrest.
Occurs most commonly in
baseball and lacrosse
Second leading cause of sudden
cardiac death in young athletes.
The survival rate of an individual
declines approximately 10% for
every minute that passes without
defibrillation.
Since 1998, more than 224 youngsters have died from this
condition, according to the Commotio Cordis Registry.
N.A. Mark Estes III, MD, and Mark S. Link, MD, from the Cardiac Arrhythmia Center at the Tufts Medical
Center in Boston, Massachusetts. Commotio Cordis Registry (Minneapolis, Minnesota).
Why do this?
 Don’t always have doctors and nurses on the fields
during games
 Don’t know where lightening will strike
 SCA is not so rare
 SCA can happen secondary to other injuries
 AEDs are easy to use; don’t make mistakes
 Anyone can help save a life
Incidence
 The precise incidence of commotio cordis in
children is unknown because of the absence of
systematic and mandatory reporting, but based upon
data from the National Commotio Cordis Registry in
Minneapolis > 224 deaths-last 12 yrs
 It is among the most frequent cardiovascular causes
of sudden death in young athletes, after
hypertrophic cardiomyopathy and congenital
coronary-artery anomalies
Look at your own safety
 Would you cancel your home owners insurance since you had
no claims in 10 yrs?
 Would you cancel your health insurance since you have been
healthy for 10 yrs?
 Would you allow your children’s schools to remove fire
extinguishers since they had no fires in 10 yrs?
 Would you remove the seatbelts from your car?
 Would you ride a motorcycle without a helmet?
 Would you let someone die because you were not informed or
trained to do something simple?
Who is at Risk?
 About 50% of commotio cordis events have been
reported in young competitive athletes (mostly those
between 11 and 20 years of age)
 Typically baseball, softball, ice hockey, football, or
lacrosse
 In baseball, for example, commotio cordis is often
triggered when players are struck in the chest by
balls that have been pitched, batted, or thrown in a
variety of scenarios
Distribution of Commotio Cordis Events According to Age and
Activity
Maron B and Estes N. N Engl J Med 2010;362:917-927
Mechanism of Commotio Cordis
Maron B and Estes N. N Engl J Med 2010;362:917-927
Examples of Circumstances in Which Chest Blows Have Triggered Commotio Cordis
Maron B and Estes N. N Engl J
Med 2010;362:917-927
Is it Instantaneous?
 Although cardiovascular collapse is virtually
instantaneous, 20% of victims remain physically
active for a few seconds after the blow (e.g.,
continuing to walk, run, skate, throw a ball, or even
speak), which may reflect individual tolerance for
sustained ventricular tachyarrhythmia.

(For example, a baseball pitcher struck in the chest by a batted ball was able to
retrieve the ball at his feet, successfully complete the play (throwing out the
base runner), and then prepare for his next pitch before collapsing.

In another instance, a batter was struck by a pitch while attempting to bunt and
collapsed only after running to first base.)
What are the Fact about
Chest Protectors?
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Commercially available chest protectors may be inadequate in the
prevention of sudden death due to commotio cordis.
Reasons include the fact that the protector may move when the arms
are raised, leaving the precordium exposed composite material the
protector is made from does not adequately attenuate the blow.
Under experimental conditions, the likelihood that ventricular
fibrillation will be triggered by a projectile the size of a baseball
increases progressively up to an impact velocity 40 mph, a speed
typically delivered by 11- and 12-year-old pitchers.
224 fatal cases of commotio cordis recorded in the National
Commotio Cordis Registry shows that in competitive sports, almost
one third (40 of 125) of the athletes who died as a result of the event
were wearing a chest barrier.
Chest Protection and Commotio Cordis
Failure of Commercially Available Chest Wall Protectors
To Prevent SCA. Pediatrics 2006; 117: 656-662. N.A Estes, B Maron
Maron B and Estes N. N Engl J Med 2010;362:917-927
Baseball and lacrosse chest protectors that were tested against chest
blow-induced VF
Weinstock, J. et al. Pediatrics 2006;117:e656-e662
Copyright ©2006 American Academy of Pediatrics
Baseball chest protector design tested in this experiment
Weinstock, J. et al. Pediatrics 2006;117:e656-e662
Copyright ©2006 American Academy of Pediatrics
Survival with AED
Chance of survival
 When defibrillation is delivered within
one minute, the reported survival rate
can be as high as 90%
 For defibrillation within five minutes,
the survival rate can be as high as 50%
 Without defibrillation, survival is less
than 5%
 After 12 minutes, the usual time it takes
local EMS to arrive, it usually is too late
to revive the victim
NEJM 2000
Ideal "Collapse-to-Shock"
Goal for Early
Defibrillation Programs
Goal: < = 3 - 5 minutes
AED Reliability
96% of the time they are able to
detect a rhythm that should be
defibrillated
100% of the time they are able to
recommend NOT shocking when
the computer shows defibrillation
Is not necessary
Window=5-6 minutes
Improvements in Survival
 Registry data show that survival rates have increased:
 Rising to 35% over the past decade, as compared with 15%
for the preceding 10— between 2006 and 2009 — the number
of successful resuscitations exceeded the number of deaths
by 20%.
 Result of increased public awareness, the increased
availability of automatic external defibrillators (AEDs), and
earlier activation of the chain of survival (call to 911 and
initiation of cardiopulmonary resuscitation, defibrillation,
and advanced life-support measures).
Hey Coach: Do You Know Where The AED is?
Goals:
To Make Youth Baseball the safest organization it can be
Purchase AEDs for our fields
Incorporate AED training and awareness into orientation for all
coaches involved with YB
Provide SCA-AED simulation drills
Encourage simple screening for SCA risk
Emergency Plan
 Establish an emergency action plan at all athletic venues.
 Develop a communication system that includes local EMS phone
numbers
 Simple training of all coaches on AED usage and SCA
 INSTALL AEDs in ALL high risk sports venues
 Location is Key!
 Make sure it readily is available and posted in high-visibility
areas.
 Players should receive a complete physical exam before
participating in sports activities and fill out a questionner
What else can be done?
 Consider using chest protectors and safety balls
 Install AEDs in all sports venues
 Provide access to all AEDs within 5 minutes
 Implement “chain of survival” – an immediate call to 911,
early CPR, early defibrillation and immediate transport to
hospital.
 Provide education and training for all coaches
 Institute a refresher training every 2 years, (AHA)
Local Children: Victims of SCA. No AED
Available
Nader Parman
In May 2002, seven-year-old Nader was hit in the chest
with a basketball between heartbeats, triggering
sudden cardiac arrest. The injury is called Commotio
Cordis. If an automated external defibrillator (AED) had
been available, Nader’s life could have been saved.
SCA Victim
Greg Moyer: Notre Dame High School--NO AED

Greg played 10 minutes in a basketball game on December 2, 2000, when he
walked into the locker room and went into sudden cardiac arrest. No AED was
available, and CPR was not started for more than 10 minutes. Paramedics did
not arrive for 30 minutes, at which time his heart began to beat after being
shocked with an AED. He was unable to sustain his heartbeat and died.
SCA Victim
 Louis Savino:
Cousin attended St. Andrew-Newtown
 Died on Maccles Field-Yardley-off River Road


Louis, age 15, died on October 12, 2000, during soccer practice. Cause of death was
undetected Hypertrophic Cardiomyopathy (HCM).
SCA Victim
Louis Acompora
 Louis died at age 14, March 25, 2000, during a
lacrosse game. In his position as goalie, Louis blocked
what appeared to be a routine shot with his chest
protector, took a few steps and collapsed. Paramedics
arrived with a defibrillator almost 15 minutes later.
Louis died from Commotio Cordis,
Victim of SCA
 Nick Over
On the morning of April 8, 2001, Nick was found unconscious
in his bed. His parents found him and immediately dialed 911. He was worked on at
home and in the hospital, but could not be revived. Cause of the fatal sudden
cardiac arrest was found to be Arrhythmogenic Right Ventricular Dysplasia (ARVD)
Recent Death
Autopsy confirmed he died of heart contusion
May 20, 2010
Survivor-Passed Out
Daniel Fucich: Holy Ghost Prep-August 2009
Shocking rescue from clutches of death
Shocking rescue from clutches of death
Bucks County Courier Times-March 2010
John Cochrane, the coach of his 13-year-old grandson Hunter's youth
basketball team, suffered a heat attack March 7 in the last two minutes
of a Warminster Basketball Association game at William Tennent High
School. Warminster Fire Chief Mitch Shapiro, whose son was playing in
the game, and two parents who are nurses, rushed onto the court and
used an automated external defibrillator to revive Cochrane
George School Coach
 May 2010
 SCA-life was saved by an AED
 Heart bypass 2 days later
Holland Parent
 This May, 2010 a Holland, PA father was pitching to
his son in the batting cages and suffered SCA.
 He died in front of the Holland LL president and 2
entire baseball teams, including his son
 No AED was available
 EMS arrived but was unable to revive
 Lessons learned about EMS activation-give specific
directions, stay on phone, send flaggers to street
Survivors-AED

16-year-old Zach suffered cardiac arrest during class in October, 2009.
The availability of an AED and the actions of the school nurse saved his
life., Zach has returned to school and opened a savings account to collect
donations to provide AEDs, training and education to local non-profit
organizations. He is expected to make a full recovery.
Survivor-AED
 Matt Keene On October 18, 2006, as a routine football practice , Matt collapsed on
Survivor-AED
 Matt Nader Matt collapsed during a football game.
His mother performed CPR as he laid on the track,
but the use of an automated external defibrillator
saved his life. -
Survivor-AED
 Teddy Okerstrom

16-year-old Teddy collapsed on June 16, 2009, while