Sudden death revisited

Monday, November 5, 2007

The New York City medical examiner reported that more tests were needed and the results of the autopsy were inconclusive. His father told the Detroit Free Press that he was told by hospital personnel that he died of a cardiac arrest. Ryan Shay collapsed in the fifth mile of the US Olympic Marathon trials. One of the favorites to win the race and qualify for Beijing 2008, instead died a very public and very quick death. Cardiac arrest sounds very medical but it means little. We all die of cardiac arrest. The words mean that the heart has stopped. It’s like having your mechanic tell you that your car doesn’t run. Pretty general and not very specific.

In October this year, an Italian medical study was presented at the European Cardiology Congress that used aggressive screening tests to make sure athletes wouldn’t die during practice or competition. By using EKGs and echocardiograms (an ultrasound of the heart), athletes who might have an abnormal heart may be found and potential sudden death can be prevented. The screening is relatively expensive and time consuming, but thought to be important enough to have it recommended countrywide.

Screening is wonderful if you’re an athlete, but in many ways, we’re all athletes, from those who use their bodies as tools, in the construction trades or in factories to the weekend warriors trying to enjoy the thrill of competition as they gradually age. Every person cannot be tested and there is no guarantee in life, even if the fine print o the latest exercise video suggests that you check with your doctor before beginning.

And if screening doesn’t work, what alternative is there if the guy next to you collapses? The answer may be electricity. Almost all sudden cardiac death occurs because the electricity in the heart short circuits and causes the heart to quiver like jello, instead of beating in a coordinated fashion. No coordinated heart beat, no blood flow to the body and the brain; no blood flow to the brain and life is over in 4 – 6 minutes. Shock the heart back to a normal rhythm and there is a chance to cheat death.

In an eerie coincidence, Sports Illustrated wrote this week of the sudden death of Alberto Salazar, one of the icons of the marathon. He collapsed but bystanders began CPR, another ran for an AED, an automatic external defibrillator, another called 911. The system worked and the dead Salazar was revived to return to his normal life.

(Before I launch this next paragraph, a disclaimer. In the many years that I have practiced emergency medicine, I have never seen a person collapse on the street in front of me or in a an airplane or anywhere other than in my own hospital’s ER.)

Medical technology is always thought to be extremely expensive but AEDs are omnipresent at shopping malls, airports, perhaps at your school. Why not in your car or at your home? How much would it be worth to have the electricity at hand that could save a life? An AED costs about $1500, or about the price of a good theater system for your car.

Sudden death is term used loosely in sports at the end of a close game. It’s not meant to be literal. The public has the tools to fight death: Learn CPR. Know where the closest AED is kept. Call 911. Pass the word.

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