Sunday, July 9, 2017
Sports terms make their way into our everyday world. From closing a slam dunk deal and being thrown a curve in a relationship to chasing a dream by keeping an eye on the ball, our language is peppered with sayings that aren’t to be taken literally. Then there is sudden death, a term that bounces back and forth from cardiology to sports overtime and back again. In medicine, sudden death is very black and white, marking the second when the heart stops beating, blood stops pumping and the brain and other organs stop working. While in sports, the final score ends the game, in medicine there is a chance at redemption, if the heart can be quickly restarted in minutes or less, the brain and body may recover. That is a big may and the final outcome may not be evident immediately.
Imagine being in the stands, cheering for your favorite team, when a player collapses. Imagine being in the stands when Dutch soccer team, Ajax, takes the field. Early in the game, a young 20-year-old player named Abdelhak Nouri collapses to the ground. Initially, there is little concern; after all it is soccer and players routinely dive to draw a penalty. Bu there was no foul and he lay motionless as the game quickly stops and medical staff rush on the field and start CPR. An automated defibrillator (AED) is used while screens are held around the scene to provide some privacy in a stadium filled with fans. But unlike television, Mr. Nouri doesn’t immediately stand up, he is unconscious and while his heart has been shocked and restarted, the brain and body haven’t yet recovered and he is placed on a ventilator, a machine that breathes for him, as he is helicoptered to the hospital and kept in a medically induced coma to hopefully allow his brain to recover.
The heart is an electrical pump. Sudden death occurs when the heart’s electrical system short circuits and the regular electrical pattern that signals heart muscle to beat is lost. Instead of normal sinus rhythm, a coordinated signal to every ventricle muscle cell to contract at the same time and pump blood to the body, the chaotic electrical rhythm causes each cell to contract randomly. The ventricles, the lower pumping chambers of the heart, sit their jiggling like a bowl of Jell-O instead of squeezing like it’s supposed to do. Ventricular fibrillation (V Fib) is not compatible with life and the only treatment that works is electricity, shocking the heart back into a regular rhythm,
With the advent of AEDs, bystanders can become lifesavers, if V Fib is the reason a person collapses and dies. CPR is the temporary stopgap that can provide some blood flow to the brain until the AED gets to the patient’s side, but CPR doesn’t fix what’s wrong. The AED is almost foolproof and walks the bystander through the steps of providing a shock if the cause of death if a shock is appropriate (some people have sudden death and the abnormal rhythm is not V Fib), delivering a shock is as easy as starting a car. And a reminder to those who are afraid of making a mistake…the victim is already dead, they can’t get any worse.
If the AED shock works and the heart restarted, hopefully, paramedics or EMTs are there to take over and then the hard work begins. Unless the person wakens immediately, the basic vital signs need to be controlled and stabilized, from breathing to blood pressure, the body needs help in getting regulated. Once at the hospital, an unconscious survivor of sudden death may be cooled just a little to help protect the brain and kept in a coma while the dust settles. Hopefully, the victim wakens and returns to normal function. That is not a given.
Sudden death happens suddenly without warning. Cheating death can only happen when bystanders are there to start CPR and find and use an AED. When elite athletes collapse, it is a reminder that anybody can become a victim and anybody can become a hero.
A reminder that here are two type of fibrillation:
- Ventricular fibrillation affects the lower chambers of the heart that pump blood to the body and is not compatible with life.
- Atrial fibrillation is a common condition affecting more than 5 % of the population and describes the inability of the upper chambers of the heart to beat in a coordinated fashion. This is not an immediate life threatening condition, though long term complications do exist