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Transcript
Sudden Cardiac Death How common is it ? “Of the 728,743 heart disease deaths in 1999, 462,340 (63.4%) were defined as sudden cardiac deaths (SCD). These high numbers of sudden deaths from heart disease, and the fact that they occur outside of the hospital, are alarming," Jeffrey P. Koplan, MD, MPH Director, Centre for Disease Control, Feb 2002 In Ireland, this corresponds to some 6,000 sudden cardiac deaths annually What is sudden Cardiac Death ? • Cardiac arrest • • • • • • • ‘A massive heart attack’ He ‘just dropped dead’ He ‘died in his sleep’ ‘A massive stroke’ ‘A huge clot to his heart’ Cot death Sudden Infant Death Syndrome (SIDS) • Sudden Heart Failure • Sudden Adult Death Syndrome (SADS) Death occurring within one hour of onset of symptoms due to cardiac causes Normal Rhythm Ventricular Tachycardia Ventricular Fibrillation 2 8 year old man who died suddenly while wearing a cardiac monitor Valvular Heart Disease Viral Hypertrophic Myocarditis Cardiomyopathy Dilated Drugs Cardiomyopathy Commotio Ventricular Cordis Fibrillation Channelopathy Electrocution Coronary Wolf-Parkinson White Syndrome Sudden Infant Death Syndrome Artery Disease Time from Collapse Normal Rhythm Ventricular Tachycardia Likelihood of success with defibrillation 0 mins >90% 2 mins 80% 10 mins <10% 2 8 year old man who died suddenly while wearing a cardiac monitor Ventricular Fibrillation # Deaths per million/yr Causes of SCD by age 2500 2000 1500 1000 500 0 0 10 20 CAD 30 40 50 Cardiomyopathy 60 70 Channelopathy 80 90 Age (yrs) Causes of SCD under 50 years # Deaths per million/yr 500 450 400 350 300 250 200 150 100 50 0 0 10 20 30 40 50 Age (yrs) CAD Cardiomyopathy Channelopathy What can you do about it ? 1. Prevention through screening 2. Prompt defibrillation Screening 1. Principles 1. 2. 3. 4. Practical Reliable High sensitivity and specificity Cost effective Screening 2. Questionnaire 1. Do you have a first degree relative who dropped dead suddenly under 50 y.o. or who has been diagnosed with a heart condition ? 2. Have you had a blackout for no obvious reason ? 3. Have you had sudden onset rapid heart beating ? 4. (Do you get chest tightness or shortness of breath out of the ordinary while exercising ?) 5. If yes to any of above, refer to GP. 6. If significant family history or symptoms, refer to local cardiologist for further testing Screening 3. Cardiac Tests 1. 2. 3. 4. Electrocardiogram Exercise Test (Steps or treadmill) Echocardiogram (Ultrasound) 24 hour Holter Monitor Problems with Screening 1. 2. 3. 4. 5. Indeterminates / False positives False negatives Myocarditis / Commotio Cordis How often should they be repeated What to do with ‘true positives’ Sir Rannulph Fiennes after completing 7 marathons in 7 days on 7 continents… …6 months after cardiac arrest and bypass surgery The Solution to out of hospital Cardiac Arrest is shocking The Automatic External Defibrillator (AED) Commotio Cordis 13 y.o boy hit with a baseball in the chest and successfully resuscitated with an AED by passing police officers Cardiac Arrest Survival Rates • Chicago 1988 1% • Seattle 1998 24% (First responder programme) • Las Vegas 1999 30% (overall) 72% (3 mins) • Ireland 2003 ~ 1% 80% of cardiac arrests occur at home 70% of cardiac arrests are witnessed The Problem How do we get AEDs to cardiac arrest victims within 5 minutes of collapse ? Possible strategies; 1. Increase density of ambulance dispatch centres 2. Police cars 3. Public Access Defibrillation • Sports venues / clubs • Shopping Centres • Golf Clubs • All airplanes • Gyms • Jails 4. First Responder programmes Ambulance Dispatch Centres 77 10 The Problem How do we get AEDs to cardiac arrest victims within 5 minutes of collapse ? Possible strategies; 1. Increase density of ambulance dispatch centres 2. Police cars 3. Public Access Defibrillation • Sports venues / clubs • Shopping Centres • Golf Clubs • All airplanes • Gyms • Jails 4. First Responder programmes Progetto Vita in Piacenza, Italy, 39 semiautomatic external defibrillators Survival 12 1999 12 high-risk locations, 12 lay-staffed ambulances 15 police-cars. 1285 lay volunteers trained to intervene 10 8 Total % 6 11.1% (43.7%) (Shockable Rhythms) 4 2 2.9% (16.6%) The first experience of out-of-hospital early defibrillation by non-medical volunteers in a medium-size European city. 0 266,531 inhabitants Conventional EMS Progetto Vita P<0.05 197 Cardiac arrests The Problem How do we get AEDs to cardiac arrest victims within 5 minutes of collapse ? Possible strategies; 1. Increase density of ambulance dispatch centres 2. Police cars 3. Public Access Defibrillation • Sports venues / clubs • Shopping Centres • Golf Clubs • All airplanes • Gyms • Jails 4. First Responder programmes Community First Responder Scheme Incoming Call Control Centre Regional Operator 999 Nurse Emergency Medical Technician Physician Fire Brigade Police Station / Patrol Car Trained Community Member 2 members of local community response team on call carrying pager/mobile and AED Ambulance Victim What can the GAA do ? • Adopt a policy supporting the widespread deployment of AEDs in clubs • Encourage clubs to raise money locally to purchase an AED and train all / most coaches in their use (4 hr training course) • AEDs cost ~ €2,500. • Could clubs become the location for a community’s AED ? What can coaches do ? • Get trained and encourage colleagues to get trained in basic life support (BLS) – AED • Nearest training centre details available from The Irish Heart Foundation • Know how to recognise cardiac arrest and teach others • Have a response strategy for your club (AED / 999 / CPR) • Find secure but accessible location for AED in the club • Task Force on Sudden Cardiac Death guidelines to be discussed with sporting groups and published in 2005 The solution is shocking Marc-Vivien Foe Cormac Mac Anallen Miklos Fehrer John McCall