Page 153 - Athletic Health Handbook
P. 153
arrhythmias. Preventive strategies are
currently limited to teaching youth
baseball players to turn their chest
away from a wild pitch, a batted ball,
or a thrown ball. Several recent case
reports have shown that automatic
external defibrillators (AED) can
successfully resuscitate patients with
this condition.

Automatic External Defibrillators related cardiac events. Participation system is obligated to purchase or
guidelines for athletes with cardio- rent an AED, the decision as to what
Automatic external defibrillators are vascular disease are detailed in the location or which venue it should be
devices that analyze cardiac rhythms recommendations of the 26th kept may be difficult. Should it be
and give electric countershock when Bethesda Conference. (Maron kept in the baseball dugout or across
the device has determined the BJ, Mitchell JH. 26th Bethesda campus on the lacrosse field? If an
patient’s heart is in a malignant Conference: recommendations for AED is kept on site, does the team
rhythm. AEDs are small and portable, determining eligibility for competi- physician become legally responsible
have been used for several years by tion in athletes with cardiovascular for its maintenance and proper use
emergency personnel, and have abnormalities. J Am Coll Cardiol in emergencies involving athletes and
become an important link in the 1994;24(4):845-99.) Commotio spectators? These are among the many
“chain of survival” as defined by the Cordis is the exception to this rule as issues that need to be considered when
American Heart Association. (Kerber these individuals have no known risk evaluating the appropriateness of
RC, Becker LB, Bourland JD, et al: factors and normal screening exams. mandating AEDs for use in athletic
automatic external defibrillators settings. Their potential benefit is
for public access defibrillation: At this time the availability of undeniable—yet blanket recommen-
recommendations for specifying and AEDs at sporting events is not current dations without careful consideration
reporting arrhythmia analysis algo- standard of care in most communities. of all the issues should not be “auto-
rithm performance, incorporating New York State has enacted legislation matic.” Written guidelines addressing
new waveforms, and enhancing to require certain public school facil- an emergency action plan with regard
safety. Circulation 95: 1677-1682, ities to retain on premises at least one to care of the athletes and the specta-
1997.) The availability and use of functional AED. (The Record 5/16/02) tors may be prudent before placing
AEDs may be useful in this setting as However, despite the potential bene- these devices at sporting events.
dysrhythmias, particularly ventricular fit of these machines, the issues
fibrillation, play an important role surrounding efforts to mandate their In conclusion there are numerous
in the mechanism of sudden death. use are more complex. Cost will cardiovascular benefits from aerobic
Two cases of commotio cordis with always be a major factor for many exercise. However, there is also an
resultant ventricular fibrillation have communities and school systems extremely low risk of cardiovascular
been reported successfully treated by with devices ranging in price from collapse in susceptible individuals as
prompt use of an AED. (Maron BJ, $1,200 to over $3,000, not including well as the risk of trauma-induced
Gorham TE, Kyle SB, et al. Clinical continued maintenance costs. Should commotio cordis. Proper prepartici-
profile and spectrum of commotion a school be forced to use valuable pation screening and on-field auto-
cordis. JAMA 2002;287(9):1142-6.) resources on a device that treats a matic external defibrillators may help
These two subjects accounted for 10 condition that must be regarded as to reduce the incidence of these
percent of all survivors of commotio exceedingly uncommon? If a school often tragic events.
cordis in the study population. While
most health care professionals would
agree that the availability of an AED
at all sporting events is ideal, preven-
tion through the use of appropriate
pre-participation screening is more
likely to minimize overall athletic

SUDDEN CARDIAC DEATH AND AUTOMATIC EXTERNAL DEFIBRILLATORS 153
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