Sudden Cardiac Arrest Is A Leading Killer Of College Athletes
Basketball fans attending Loyola Marymount University’s game against the University of Portland in March 1990 thought they were in for a spirited semifinal game. But then the unthinkable happened: 23-year-old Hank Gathers, a 6-foot 7-inch superstar, collapsed on the court. Stunned fans later learned that he died of sudden cardiac arrest — a condition that still kills between five and 10 NCAA athletes every year. Now, 26 years later, the NCAA has issued new guidance on how to prevent those kinds of deaths.
It’s the result of a multi-year process initiated by the association, which convened a task force of cardiovascular and sports medicine experts, student athletes, and athletic trainers to decide what to do about sudden cardiac deaths in sports back in 2014. The group came up with a consensus statement recently published in the Journal of the American College of Cardiology. The document identifies the purpose of pre-participation evaluations, best practices for those screenings, and guidelines for how officials should plan for and handle emergency cardiac arrest when it’s in progress.
Just how bad is the problem? In 2011, researchers from the University of Washington at Seattle used an NCAA database, public media reports, and catastrophic insurance claims to come up with an incidence rate for sudden cardiac death among students who died suddenly during exercise. They found that 75 percent of sudden deaths among student athletes who died during exercise could be traced to cardiovascular causes and that the current methods of collecting data underestimate the risk of sudden cardiac death.
The NCAA itself found that the risk of a male athlete dying from sudden cardiac arrest is one in 38,000 and only one in about 122,000 for female athletes. Basketball, soccer, and football players appear to be at the greatest risk — though only 4 percent of NCAA athletes are basketball players, they represent a full 20 percent of all sudden cardiac deaths.
But though the recommendations give guidelines on how to use electrocardiograms (ECGs) to predict those kinds of risks to student athletes, they stop short of actually recommending them. “We’re not mandating or recommending that they be done across the board,” says Brian Hainline, staff senior vice president and chief medical officer of the NCAA. In 2015, Hainline, who is the NCAA’s first-ever chief medical officer, backtracked on a publicly announced plan to require all student athletes to receive ECGs when team physicians from over 100 universities protested.
“Look, people have been talking about electrocardiogram screening for a long time, but it's been so polarized that you have two camps and the two camps just keep saying the same thing and you're not moving forward in a consensus-driven manner," Hainline says. One camp insists that EKGs are a critical predictive tool that can identify cardiac conditions, like myocarditis, a disease that inflames and can damage the heart muscle and that is associated with sudden cardiac death. The other holds that since so few student athletes have the kinds of cardiac problems that can be detected by EKG and that put them at risk for sudden death, the procedure shouldn’t be performed as a requirement for participation — a position held by organizations like the American Heart Association.
“For a lot of sudden cardiac deaths, the first symptom is sudden cardiac death,” says Justin Wright, assistant professor in the Department of Family and Community Medicine at the Paul L. Foster School of Medicine in El Paso. A sports-medicine-trained physician, Wright directs the school’s sports medicine program. “Our current system isn’t perfect, but I’m not sure that EKG screening may not be the perfect answer, either.”
The new consensus statement neatly sidesteps the EKG issue: It provides best practices for institutions that choose to require the tests as part of screening, but stops short of recommending it be implemented across the board. It may be cautious when it comes to how to predict cardiac arrest risks, but when it comes to how organizations should treat it while it’s happening, the statement minces no words. “The debate about the effectiveness of various screening examinations … will undoubtedly continue,” it reads. “However, there is no debate that a well-rehearsed and effectively implemented [emergency action plan] ... is effective at reducing the risk of death.”
To that end, the statement insists that coaching staff, referees and other responders be trained, that emergency plans be in place, and that working automatic external defibrillators (AEDs) be available during practice and play. When Gathers collapsed back in 1990, CPR was initially not administered because he was responsive. However, an AED was unsuccessfully used to save his life, and once Gathers registered no pulse, CPR was unsuccessfully used.
Perhaps a more cohesive emergency plan — or a more rigorous cardiovascular screening — could have saved Gathers. But Hainline hopes that the new guidelines can keep today’s athletes and those of the future from dying during sports. “No matter what we do, there’s always going to be a risk of someone dying of sudden cardiac arrest,” he says. “In all sports settings the most important thing we can do is make certain that all of the appropriate people are CPR and AED trained.”
Wright, who oversees medical game coverage for the University of Texas at El Paso and local high schools, agrees. “Everyone thinks they’re going to rise to the occasion, but most of the time we fall back to our level of training,” he says. “It’s not difficult to learn CPR.”
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