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Sudden cardiac arrest (SCA) is the leading cause of exercise-related fatalities in athletes. A comprehensive emergency action plan (EAP) is critical to facilitate a rapid and effective response to a cardiac emergency. SCA should be suspected in any athlete that collapses suddenly and is unresponsive. All potential responders to a collapsed athlete should be trained in the recognition of SCA, cardiopulmonary resuscitation, and use of an automated external defibrillator (AED). AEDs should be accessible on-site at sporting venues with a target collapse to first shock interval of less than 3 min. Every school, club, and sporting organization that sponsors athletic activities should have a written EAP for SCA. An EAP coordinator should be designated to foster compliance with training, practice, and rehearsal of the EAP at least once annually. Some sports require special considerations for equipment removal or access to emergency services in geographically broad or water-based venues.

Children, adolescents, and young adults with conditions such as cardiomyopathies and channelopathies are at higher risk of sudden cardiac death caused by lethal arrhythmias, especially ventricular fibrillation. Timely defibrillation saves lives. Patients thought to be at significantly high risk of sudden death typically undergo placement of an implantable cardioverter-defibrillator. Patients thought to be at lower risk are typically followed medically but do not undergo implantable cardioverter-defibrillator placement. However, low risk does not equal no risk. Compared with the general population, many of these patients are at significantly higher risk for lethal arrhythmias. We make the case that such individuals and families will benefit from having an at-home automatic external defibrillator. Used in conjunction with conventional measures such as training on cardiopulmonary resuscitation, an at-home automatic external defibrillator could lead to significantly shortened time to defibrillation with better overall and neurological survival. We recommend that the cost of such home automatic external defibrillators should be covered by medical insurance.

Aim: To investigate out-of-hospital cardiac arrest (OHCA) trend, provided advanced life support (ALS) measures, automated external defibrillator (AEDs) utilization and bystanders’ involvement in cardiopulmonary resuscitation (CPR) during OHCA incidents.

Methods: This cross-sectional study encompassed data pertaining to all OHCA incidents attended to by the Emergency Medical Service of Canton Sarajevo, Bosnia and Herzegovina, covering the period from January 2018 to December 2022.

Results: Among a total of 1131 OHCA events, 236 (20.8 %) patients achieved return of spontaneous circulation (ROSC); there were 175 (74.1%) males and 61 (25.9%) females. The OHCA incidence was 54/100,000 inhabitants per year. After a 30-day period post-ROSC, 146 (61.9%) patients fully recovered, while 90 (38.1%) did not survive during this timeframe. Younger age (p<0.05), initial rhythm of ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) (p<0.05), and faster emergency medical team (EMT) response time (p<0.05) were significantly associated with obtaining ROSC. Only 38 (3.3%) OHCA events were assisted by bystanders, who were mostly medical professionals, 25 (65.7%), followed by close family members, 13 (34.3%). There was no report of AED usage.

Conclusion: This follow-up study showed less ROSC achievement, similar bystanders’ involvement, similar factors associated with achieving ROSC (age, EMT response time), and a decline in OHCA events (especially in year 2021 and 2022) compared to our previous study (2015-2019). There was an extremely low rate of bystander engagement and no AEDs usage. Governments and health organizations must swiftly improve public awareness, promote better practice (basic life support), and actively encourage bystander participation.

Background: Out-of-hospital cardiac arrest is a public health crisis affecting about 356,000 adults and 23,000 children annually in the US with 90% fatality. Early bystander CPR and AED application improve survival. Less than 3% of the US population is CPR trained annually. Since 20% of the US population is at school daily, these represent ideal places to target CPR training. Having standardized state school CPR and AED laws will help with training.

Methods: We performed a systemic search of the state-specific laws for school AED and CPR requirements within the US. We used PubMed and Google search using keywords: school CPR mandates, US laws for CPR in schools, US state laws for AED implementation, and gaps in US school CPR and AED. We searched for mandates for schools in other countries for comparison.

Results: The state laws for CPR training for high school graduation and AED requirements in US. schools are highly variable, and funding for AEDs is inadequate, especially in schools in lower socio-economic zip codes. Recent AED legislative efforts focus mainly on athletic areas and don’t adequately address school size, number of buildings, non-athletic areas, and engagement of student-led advocacy efforts.

Conclusion: To improve OHCA survival, we identified potential solutions to consolidate efforts and overcome the barriers-standardize state laws, involve student bodies, increase funding, and allocate appropriate resources. The CPR/AED education needs to start earlier in schools and be part of the standard curriculum rather than implemented as a stopgap check-box mandate.

 

Objective: To examine sudden cardiac arrest (SCA) awareness and emergency preparedness for SCA in Amateur Athletic Union (AAU) youth basketball teams.

Design: Cross-sectional survey of AAU coaches and administrators.

Setting: Random sampling of AAU club teams across the United States.

Participants: AAU club coaches and/or administrators.

Interventions: Electronic survey (Qualtrics) accessed online and by cell phone. Each coach/administrator was invited to participate via email up to 3 times, spaced approximately 5 days apart.

Main outcome measures: Established and practiced emergency action plan (EAP), cardiopulmonary resuscitation (CPR) training, and automated external defibrillator (AED) access.

Results: A total of 53/449 (12%) respondents completed the survey. Only 6% of responding AAU clubs had a written EAP and practiced it on an annual basis. Only 35% of clubs required CPR training for their coaches. Automated external defibrillator were available at practices and games in only 45% and 35% of AAU clubs, respectively. Over 50% of clubs did not have an affiliated athletic trainer or medical director.

Conclusion: The vast majority of AAU clubs in this study lack proper emergency preparedness for SCA. Given male basketball players are at highest risk of SCA compared with other young athlete populations, urgent interventions are needed to improve awareness, standardize training, establish EAPs, and ensure access to AEDs in AAU clubs.

 

Background: Sudden cardiac arrest (SCA) is the leading cause of student-athlete mortality, often described interchangeably as sudden cardiac death (SCD). For persons aged ≤35 years, structural heart disease, such as hypertrophic cardiomyopathy, is historically the most common etiology. Regarding individuals aged >35 years, coronary artery disease is the main contributor to SCD during exercise.

Indications: Though some athletes may endure prodromal symptoms prior to a SCA, approximately 25% to 50% do not. Up to 23,000 people aged <18 years die from SCA annually. SCA athlete deaths are reported to be the most common medical cause of death and the second most common overall behind motor vehicle accidents in this population. Therefore, it is important to acknowledge SCA prevalence and identify at-risk competitors.

Technique description: If a SCA is suspected, first assess surroundings for safety and athlete response to commands. Should there be no pulse, activate code. If necessary, an athlete’s shirt may be removed or cut to better access the bare chest for the automated external defibrillator (AED) pads. Apply pads and commence compressions. Refer to the AED for a shockable rhythm between compression cycles. Establish intravenous access as appropriate and if feasible. After 1 cycle of compressions, a shock is administered when a shockable rhythm is detected. Resume compressions if a pulse is not reestablished. If a pulse is reestablished, the athlete should then be immediately transported to the hospital.

Results: A literature review yields illustration of the multifactorial criteria that comprise return-to-sports guidelines, including activity intensity, extent of cardiac disease, and psychological/physical benefit from sport. SCD incidence is higher in competitive versus recreational athletes. In general, consolidation of these investigations makes it apparent that utilizing a shared decision-making process and a progressive exercise program is warranted prior to play resumption in most cases. The greatest SCA/SCD survival determinant is collapse to defibrillation time.

Discussion/conclusion: The American Heart Association/American College of Cardiology and the European Society of Cardiology recommend preparticipation cardiac screening to identify cardiac conditions that predispose to SCA/SCD risk. SCD prevention in athletes hinges on the prompt availability of quality cardiopulmonary resuscitation and AEDs.

Patient consent disclosure statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

 

Aims: To study aetiologies of in-hospital cardiac arrests (IHCAs) and their association with 30-day survival.

Methods and results: Observational study with data from national registries. Specific aetiologies (n = 22) of IHCA patients between April 2018 and December 2020 were categorized into cardiac vs. non-cardiac and six main aetiology categories: myocardial ischemia, other cardiac causes, pulmonary causes, infection, haemorrhage, and other non-cardiac causes. Main endpoints were proportions in each aetiology, 30-day survival, and favorable neurological outcome (Cerebral Performance Category scale 1-2) at discharge. Among, 4320 included IHCA patients (median age 74 years, 63.1% were men), approximate 50% had cardiac causes with a 30-day survival of 48.4% compared to 18.7% among non-cardiac causes (P < 0.001). The proportion in each category were: myocardial ischemia 29.9%, pulmonary 21.4%, other cardiac causes 19.6%, other non-cardiac causes 11.6%, infection 9%, and haemorrhage 8.5%. The odds ratio (OR) for 30-day survival compared to myocardial ischemia for each category were: other cardiac causes OR 1.48 (CI 1.24-1.76); pulmonary causes OR 0.36 (CI 0.3-0.44); infection OR 0.25 (CI 0.18-0.33); haemorrhage OR 0.22 (CI 0.16-0.3); and other non-cardiac causes OR 0.56 (CI 0.45-0.69). IHCA caused by myocardial ischemia had the best favorable neurological outcome while those caused by infection had the lowest OR 0.06 (CI 0.03-0.13).

Conclusion: In this nationwide observational study, aetiologies with cardiac and non-cardiac causes of IHCA were evenly distributed. IHCA caused by myocardial ischemia and other cardiac causes had the strongest associations with 30-day survival and neurological outcome.

Out of hospital cardiac arrest (OHCA) outcomes can be improved by strengthening the chain of survival, namely prompt cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED). However, provision of bystander CPR and AED use remains low due to individual patient factors ranging from lack of education to socioeconomic barriers and due to lack of resources such as limited availability of AEDs in the community. Although the impact of health inequalities on survival from OHCA is documented, it is imperative that we identify and implement strategies to improve public health and outcomes from OHCA overall but with a simultaneous emphasis on making care more equitable. Disparities in CPR delivery and AED use in OHCA exist based on factors including sex, education level, socioeconomic status, race and ethnicity, all of which we discuss in this review. Most importantly, we discuss the barriers to AED use, and strategies on how these may be overcome.

The integration of wearable sensor technology and machine learning algorithms has significantly transformed the field of intelligent medical rehabilitation. These innovative technologies enable the collection of valuable movement, muscle, or nerve data during the rehabilitation process, empowering medical professionals to evaluate patient recovery and predict disease development more efficiently. This systematic review aims to study the application of wearable sensor technology and machine learning algorithms in different disease rehabilitation training programs, obtain the best sensors and algorithms that meet different disease rehabilitation conditions, and provide ideas for future research and development. A total of 1490 studies were retrieved from two databases, the Web of Science and IEEE Xplore, and finally 32 articles were selected. In this review, the selected papers employ different wearable sensors and machine learning algorithms to address different disease rehabilitation problems. Our analysis focuses on the types of wearable sensors employed, the application of machine learning algorithms, and the approach to rehabilitation training for different medical conditions. It summarizes the usage of different sensors and compares different machine learning algorithms. It can be observed that the combination of these two technologies can optimize the disease rehabilitation process and provide more possibilities for future home rehabilitation scenarios. Finally, the present limitations and suggestions for future developments are presented in the study.