Cardiac arrest is leading cause of death for young athletes: Here's how to protect them

Aug. 4—High-profile cases of young athletes seemingly at the pinnacle of health collapsing on the court or field after sudden cardiac arrest underscores a hazard in high school, college and pro sports.

While uncommon, such incidents are the leading cause of death in young athletes, experts tell the Dayton Daily News, meaning coaches, parents and players should be aware of risk factors and make sure teams are equipped with a plan and tools to respond to an emergency.

Black male athletes playing high-intensity sports, particularly basketball, are most at risk for sudden cardiac arrest, doctors say.

This was the case for Bronny James, the oldest son of NBA superstar LeBron James. On July 24, 18-year-old Bronny was hospitalized after suffering cardiac arrest during basketball practice at the University of Southern California. Bronny was released from the hospital on Thursday. He will continue to undergo tests to determine the cause of his cardiac arrest.

Bronny, whose full name is LeBron James Jr., committed to USC in May after the 6-foot-3 guard became one of the nation's top prospects out of Sierra Canyon School in nearby Chatsworth.

Earlier this year, NFL player Damar Hamlin suffered a cardiac arrest Jan. 2 during a game against the Bengals. Hamlin was hit in the chest while making a tackle, and after getting back on his feet, he collapsed. He was given medical treatment, including CPR, on the field for nearly 20 minutes before being taken in an ambulance to the University of Cincinnati Medical Center.

On Jan. 9, Hamlin was discharged from the hospital in Cincinnati and flown to continue care in western New York before being released from the hospital on Jan. 11.

In the Dayton area, cardiac deaths took the lives of former Springfield Catholic and NBA basketball player Jason Collier in 2005, and University of Dayton basketball players Chris Daniels in 1996, and Steve McElvene in 2016.

"It is unfortunately the leading cause of death in young, competitive athletes," said Dr. Lubabatu Abdurrahman, chief of pediatric cardiology at Dayton Children's.

Incidence rate, risk factors

High-profile cases like these highlight an often unpredictable condition that is difficult to prevent. Sudden cardiac arrest is when there is an abrupt loss of heart function, leading the person to lose consciousness and stop breathing. The condition usually results from a problem with the heart's electrical system that disrupts the heart's pumping action and stops blood flow to the body, according to the Mayo Clinic.

There are approximately 100 to 150 sudden cardiac deaths during competitive sports each year in the U.S., according to the American College of Cardiology. While it has become a popular topic, sudden cardiac death in athletes is rare-about 1 in 100,000 to 1 in 300,000 athletes, according to the Cleveland Clinic.

The incidence rate of sudden cardiac arrest also varies depending on the sport, the race of the athlete, the gender, and the intensity of play, she said.

"For example, we know that it is two to three times more common in male than female athletes, and the highest risk sports are basketball, football, swimming, and then lacrosse and soccer kind of come in the fourth place. Those are the highest risk for sudden cardiac arrest," Abdurrahman said.

In looking at men's basketball for example, those athletes represent only 4% of all male NCAA athletes, but almost 20% of all sudden cardiac deaths, Abdurrahman said.

"The male basketball player and the American football players represent almost a quarter of all male NCAA athletes but over half of all sudden cardiac deaths, so those sports are high risk," Abdurrahman said. Black male athletes playing division one NCAA basketball are also at the highest risk and have the highest incidence of sudden cardiac death, she said.

A similar trend appears among high school athletes, which can lead to tragic outcomes.

"High school athletes are generally the healthiest of our population, and therefore, it's often catastrophic, because it's always unexpected," Abdurrahman said.

AEDs on hand save lives

The underlying cause is most often a congenital anomaly or some kind of unusual cardiomyopathy, said Dr. Jacob Bradley Gibson, a cardiologist at the Premier Cardiovascular Institute with Premier Health. Cardiomyopathy is a disease where it becomes difficult for the heart to pump blood, according to the Mayo Clinic.

"It's hard to predict, hard to know, when it's going to happen," Gibson said. "I think the most important thing is that we are starting to recognize it now. More people are aware of this that when somebody collapses, we need quick medical attention with AED placement."

AED, or automated external defibrillator, is used to analyze the heart's rhythm and can deliver an electrical shock, or defibrillation, to help the heart re-establish an effective rhythm, according to the Red Cross.

AEDs, along with the training to know how to use them, are common among sports and training facilities.

"All coaches have to be CPR/AED certified," Trotwood-Madison High School athletic director Jonas Smith said. "Our coaches know where all AEDs are located on campus in case of an emergency. Also, our (athletic trainers) practice our Emergency Action Plan with all of our coaches annually and have an AED on hand at all practices."

OHSAA encourages AEDs to be at as many event sites as possible, as well as for all personnel responsible at a school-sponsored athletic event or practice to be trained in basic life support, first aid, CPR, sudden cardiac arrest. and AED use. By Ohio law, all interscholastic coaches, paid and volunteer, in the state of Ohio must have a current CPR certification.

What parents can do

Parents can also protect their kids by having them go through pre-participation examinations, which include a detailed family history and a physical exam.

"All student-athletes are required to get a thorough annual physical that lasts up to 13 months," Smith said.

Parents can even go a step further and talk to their doctor about having their child get electrocardiogram (ECG) — a test that records the electrical activity of the heart — if there is a family history linked to sudden cardiac arrest or other factors that put them at risk.

"It has its limitations, and there are still some cases that are missed because the ECG will not detect all the conditions that predispose to sudden cardiac arrest," Abdurrahman said. "It just improves on just the history and physical, and it's six times more likely to detect such conditions that would predisposed to sudden cardiac death compared to just the history and physical examination alone."

With any sports injury, it's important for the athlete to pay attention to a doctor's recommendations when recovering from an injury.

"It's paramount with any injury to make sure that rehabilitation is done consistently so that athletes can return to play ASAP once they are cleared," Smith said.

Recovery is key

Most of the time, after within a week of resuscitation after cardiac arrest, heart function returns to normal. The young athlete may still not be able to return to practice, though, as doctors need to determine what caused the cardiac arrest.

"Whatever predisposed them to the sudden cardiac arrest is still there, so even if the function looks clinically good, they're not quite ready to go back until we figure out what caused it and take steps to make sure it doesn't happen again," Abdurrahman said. "Generally speaking, there will be a lot of extensive testing that is done, and that can include not just echocardiograms, which are ultrasounds of the heart, it can include cardiac catheterization, it can include cardiac MRI, it can include genetic testing."

In some cases, young athletes may not be able to return to practice, depending on the cause.

There are a number of young athletes who have died from cardiac incidents over recent decades. They include cases like basketball player Hank Gathers in 1990, figure skater Sergei Grinkov in 1995, baseball player Darryl Kile in 2002, marathoner Ryan Shay in 2007, and basketball players Robert Traylor in 2011 and Fab Melo in 2017.

Jeff Gilbert, Jeremy P. Kelley, and the Associated Press contributed to this story.