Reading this awesome commotio cordis "save" story today reminded me of an issue that I have been raising for a number of years.
http://www.thecommunityvoice.com/article.php?id=6321
It seems counter intuitive, certainly to a lay person like myself, that an AED is far more likely to work on a 60 year old fan collapsed in the stands than on a 20 year old athlete lying on the field. It seems as if the younger (healthier?) heart should be a better candidate for a jump start. However the data is clear, in the two studies below no intercollegiate athletes were saved although several received a shock from an AED.
http://www.ncbi.nlm.nih.gov/pubmed/21081638
http://www.ncbi.nlm.nih.gov/pubmed/16177599
The obvious question is - Why? Electrophysiologists have a pretty good understanding of why, or at least why they think AED's often don't work on young athletes. The word "acidosis" usually comes up, along with a number of other popular theories.
My first question is - Can we be doing more to understand what is happening to the heart of a young athlete that arrests during or shortly after intense physical activity?
My second question is - With greater understanding can we develop new algorithms for AED's and new protocols for trained responders that will result in higher survival rates for young athletes?
My third question is - Should we/us/somebody/anybody be setting up an event data registry, that includes the downloaded ECG data from the AED, for all cardiac arrest events involving young people.
Researching cardiac arrest in the adult population is simplified by the fact that researchers can acquire data from thousands of events quite easily. Cardiac arrest in young athletes is relatively rare so to acquire even 1,000 data sets, with ECG attached, is a challenge. If there were a central registry where defibrillation program coordinators, athletic trainers and first responders from across the country could send event data it would provide researchers with the horsepower they need to make meaningful determinations. Collecting the ECG data from every event occurring at elementary schools, high schools, colleges, universities, and community sport venues would, within a few years, provide thousands of records for researchers to consider
The AED captures the earliest presenting rhythm and is more likely to contain answers than ECG's acquired by paramedics or in the ER. If the first ECG is captured after ROSC is achieved there is no record of the presenting rhythm. Knowing exactly what's happening electrically to an athletes heart within the first moments after collapse seems to me to be the first step in figuring out how to improve outcomes.
If one good thing comes out of the death of a young person it may be that the ECG downloaded from the AED (that failed to convert their tachyarrhythmia) contributes to saving young lives in the future. I know that over the past decade AED's have been applied to hundreds of collapsed athletes and sadly the ECG's captured by those devices have not contributed to a greater understanding of cardiac arrest in youth.
