Hockey’s sudden death

Tuesday, October 14, 2008

In hockey, sudden death usually refers to overtime, but sadly it was literally sudden death for Alexei Cherepanov, a 19 year pro who collapsed during a game in the Russian elite league and was declared dead at a local hospital outside Moscow. While any death is tragic, it seems that there is plenty of discussion as to what happened after Cherepanov collapsed and what might have been done to save his life.

Early autopsy reports suggest that death was due to hypertrophic cardiomyopathy, a condition where parts of the heart muscle grow abnormally thick and causes abnormal blood flow from the heart as it pumps. Sudden death is the most common first symptom where the heart’s electrical system malfunctions, ventricular fibrillation occurs and the heart stops pumping blood. V Fib is treated with electrical shocks from a defibrillator.

It seems that there were no medical persons in the arena and when they arrived, their defibrillator malfunctioned. Video of the scene showed the player lying on the bench for what seemed forever, with no CPR being performed. Contrast this to the scene when Jiri Fischer collapsed on the bench a couple of years ago at an NHL game and whose life was saved with immediate CPR and an electrical shock delivered by an Automatic Electrical Defibrillator (AED).

Before presuming North American superiority in all things medical, consider that screening high school athletes for heart disease is considered too expensive to be done routinely. At a lecture given at the 2006 meeting of the American College of Cardiology, Dr. Mark Estes addressed the issue of preparticipation physical examinations and said that “EKGs are not advocated, and there is only selective use of stress test and echo(cardiograms) …The cost per diagnosis when it’s been looked at for screening in the United States is prohibitive; it’s hundreds of thousands of dollars per patient identified.” Italy has taken a different approach and since 1982 aggressively screens its athletes. Not surprisingly, their rate of sudden death has fallen to 1/10 of the rate in the US.

The events in Russia should make us look at what is available in our own neighborhoods. We expect that our elite athletes get the best of care in practice and during the game. A cadre of athletic trainers, physical therapists and physicians watch over their every move. But what of our high school athletes or local soccer teams? It is probably unreasonable to expect the same level of medical care seen on the sideline of an NFL game but we can be our brother’s and sister’s keeper and make a difference.

Parents and coaches should learn basic CPR and first aid, not just for the game but because it makes our families and our community safer. Survival rates from heart attack increase when the general population is trained in CPR. It is better to have sudden death in Seattle than in Baltimore because it is more likely that a bystander has basic training. Survival increases even more if an AED is present. In most cases of sudden death, the one intervention that will make a difference is electricity; shocking the heart out of ventricular fibrillation back into a normal rhythm, AEDs are available in malls, airports, schools and workplaces, but is there one on the baseball diamond or the volleyball court?

Once found only in ERs and ICUs, defibrillators are mainstream and can be bought online for less than $1,200. That is about half of a premium video system for a minivan. It would probably be a piece of equipment that would never be used, but would the peace of mind be worth it?

We can learn from Alexei Cherepanov’s death that we cannot be complacent and presume that all is well when it comes to athletes and spectators alike. We should be aggressive in making our communities and gathering places safer, having trained people and equipment available. We know the importance of routine mammograms and cholesterol test to prevent disease. We should be as aggressive in screening our adolescent athletes to prevent sudden death.

Most of all, we should be our brother’s keeper.

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