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Sudden Cardiac Arrest in Children: Local Healthcare Professionals Work to Screen and Prevent

Cover Story

Issue: May 2010

By: Mirene Benitez

The day Los Gatos defensive lineman Michael “Mikey” Halpin died, he was in the best physical condition of his life. He’d spent the summer losing weight, converting fat to muscle, working on agility and building strength, earning a place on one of the top-ranked football teams in the state.

Mikey died on the Los Gatos High School campus of Sudden Cardiac Arrest (SCA). An underlying heart condition was undiagnosed, despite physical exams clearing him for school sports. There is no local or state requirement for pre-sports physicals to include an EKG that may have helped diagnose his condition. His seizure-like movements confused students, who couldn’t quickly process the need to run for help and an automated external defibrillator. Others froze, not knowing that beginning CPR might save Mikey’s life.

“No parent should ever have to bury their child, especially for something that, if detected, could have been corrected,” Tim Halpin, Mikey's Father said (pictured above sitting on the bench at Los Gatos High School that was dedicated to the memory of his son). “It’s a pain that no parent should ever live through.”

Mikey’s death led Tim and other Los Gatos parents to mobilize physicians, educators and their community to increase awareness of Sudden Cardiac Arrest and encourage more comprehensive screening of student athletes who are at particular risk. Los Gatos electrophysiologists Dwain Coggins M.D. and Matt Levy M.D. have responded, becoming physician advocates for screening student athletes.

After accidental injury, Sudden Cardiac Arrest is the number two killer of student athletes in America. Death by SCA occurs when ventricular fibrillation interrupts effective blood flow through the heart. The normal rhythm of the heart can only be restored with defibrillation, via an external defibrillator. In adults as well as adolescents, the vast majority of victims of Sudden Cardiac Arrest have experienced no symptoms—and 90% die from the arrest.

Parent Heart Watch, an advocacy group promoting community awareness of student risks of Sudden Cardiac Arrest, says many athletes undergo SCA because of underlying undiagnosed heart conditions, combined with conditions such as impact to the chest, heat stroke, asthma, allergic reaction or medication.

The American Heart Association estimates that 300-600 US student athletes die from SCA each year. The estimate is derived by analyzing media reports across the country. In Italy, where a national database collects detailed information on deaths of children and adolescents, the apparent occurrence of student death by SCA is two to three times the American estimate.

Because of those statistics—and motivated by Mikey’s death—Dr. Coggins and Dr. Levy spearheaded “Wildcat Day for Mikey” at Los Gatos High School in March, believed to be the largest single screening event of athletes in the state of California. They recruited more than a dozen cardiologists and emergency physicians, served on the planning team and personally phoned parents and guardians of students for whom further study was recommended.

“We know that this type of screening will not identify every student who is at risk, and the scope and logistics of the event were enormous. But we were committed to do what we could for students at a school so directly impacted by SCA. If we saved one child’s life, it was definitely worth it,” Dr. Coggins said.

Targeted at student athletes, including football teammates of Mikey, the screening drew more than 400 participants. Screening included medical and family history review, blood pressure, blood oxygenation and 12-lead EKG to identify irregular heartbeats.

After screening, athletes received refresher CPR training and additional training in use of automated externaldefibrillators (AEDs) to expand the number of people on the Los Gatos High School campus familiar with the devices that can talk a rescuer through each step required to safely restart the heart. Medtronics donated two AEDs to the high school and loaned many of the EKG machines needed for the screening. Almost three-quarters of the people who survive SCA do so because an automated external defibrillator was used.

Out of the 413 high school athletes screened that day, 25 were found to need further follow up. “There is always a possibility of a false positive result with this level of screening,” says Dr. Levy. “We believe it is better to follow up with false positives and have good news to give parents than for families to suffer a loss unnecessarily.”

Why focus on student athletes and not all adolescents? According to Christie Plesche, R.N., Director of Cardiovascular Services at Good Samaritan Hospital in San Jose, it is the physical activity and stress that is put on the heart in competition or practice that can cause the event to occur.

“Unfortunately, this is how a lot of these children are found to have a problem. They stress the heart with strenuous exercise and we find out that they have defects that would make them prone to going into sudden cardiac arrest. A lot of the time, it would go unnoticed if they hadn’t been playing sports,” Plesche says.

Although student athletes should be the focal point of EKG screenings for arrhythmias, Plesche believes that it is important for other children with a family history of heart disease and early death due to heart failure to get screened as well. The screenings, however, should not be for everybody. “Syncopal episodes, dizziness, chest discomfort, and shortness of breath are all symptoms that sometimes trigger that a child needs to be evaluated for this risk factor,” Plesche says. “These are the kids we need to monitor.”

While screenings are a benefit for student athletes and other at-risk children, so is education about what SCA is and how anyone can save a life if they know how to use the right equipment. The use of an automated external defibrillator is key to saving the life of anyone undergoing SCA.

The Sudden Cardiac Arrest Association website reports, “studies show that if early defibrillation is provided within the first minute, the odds are 90 percent that the victim’s life can be saved. After that, the rate of survival drops ten percent with every minute. As many as 30 to 50 percent would likely survive if CPR and AEDs were used within five minutes of collapse.”

It is beneficial to have an AED in schools, sports facilities and public areas like shopping malls and entertainment venues. Studies have shown that the devices are very user friendly, giving precise instructions, and can be used safely by anyone, including children. The AED will analyze a person’s heartbeat and will not deliver a shock unless one is medically needed. It will also prompt CPR if necessary. The defibrillator will continue to do this until the right amount of shocks and CPR are performed to stabilize the person’s heartbeat, thus bringing them back to consciousness. It could be that easy to save a life.

As the number of deaths in student athletes due to SCA increases, so does the interest of the medical community and other concerned adults. Parents like Tim Halpin have donated defibrillators to sports facilities and are on a quest to make EKG screenings for student athletes at risk of SCA mandatory. Halpin is currently working on a bill that he hopes will pass legislation in California, and eventually pass on the federal level. According to the National Conference of State Legislatures, only 12 states, primarily in the East Coast and Midwest regions, require AEDs to be present and only in some schools. No states require screenings.

“We want to move forward with legislation to see if it could be a requirement for children to have a basic EKG, costing anywhere from $80-$90,” Plesche said. “It’s a small amount of money given what you can be doing – saving a life. Young athletes need to get physicals before they start anyway, so why not go ahead and make it a standard?”

Plesche, Coggins, Levy and Halpin believe incorporating an EKG into pre-sports physicals is the optimal screening method. Plesche said, “We needed more than 200 volunteers to conduct this large scale screening, and I can’t say enough about the time people invested in this. But it would be much better for these young people to have the screening in a physician’s office, where their personal risk of SCA could be looked at in the context of their overall health and fitness.”

Good Samaritan Hospital coordinated the event, funded all of the related expenses and recruited nurses and EKG techs. The success of the screening also depended on participation by the Santa Clara County Fire Department, Public Health, and American Medical Response, who provided volunteer paramedics and other clinical volunteers, as well as Parent Heart Watch, the Elks and Los Gatos High School parent volunteers who staffed information booths and provided escort through the process. NFL quarterback Trent Edwards, NFL alumnus Steve Bono and members of the San Jose Earthquakes and Gold Pride met with students and parents, offering autographs and encouragement.

Coggins, Levy and Plesche are making efforts to organize foundations using parents, school alumni, and local celebrities to set up additional screenings for adolescents in other communities in the South Bay. Active participants at such events are current and former athletes, such as former 49ers cornerback and current alumni coordinator, Eric Wright. They are also sharing their experience with other healthcare providers to increase the number of hospitals and physicians partnering in screenings.

The mission to spread awareness about sudden cardiac arrest and save lives still needs attention and support. Few are aware of how easy it could be to prevent SCA and how big the problem really is. The need for awareness is best articulated by Tim Halpin:

“Please do a heart screening for your children before the numbers get so noticeable that everybody says, hey this has got to stop. It needs to stop now, and I just wish there were more doctors that would be supportive of it because I’ve heard the negative side from doctors as well. The way I look at it, save one child and it’s worth it. Any parent would feel that way.”

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