Transcript AVID Overall Survival - Gaelic Athletic Association

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
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•
•
•
•
•
‘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