SHU Panel Discusses Sudden Cardiac Arrest, Response, Awareness

Speakers outline causes, diagnostic tests and treatments of major public health concern

Sacred Heart University’s College of Health Professions highlighted sudden cardiac arrest (SCA), a major public health concern, in its recent Dean’s Speaker Series lecture which coincided with Sudden Cardiac Arrest Awareness Month.

The lecture, which took place on campus, was attended by students and EMS providers, with others participating virtually via Zoom.

Maura Daly Iversen, dean of the College of Health Professions, hosted the event with a panel of experts including: Mike Papale, SCA survivor and president and founder of the nonprofit In A Heartbeat; Chief Leigh Goodman, director of Emergency Medical Services in Trumbull; and SHU colleagues Julie Nolan, assistant professor of athletic training, and Adam Olsen, clinical assistant professor and former chair of physician assistant studies who is a practicing physician assistant in cardiology for the past 19 years.

Olsen showed a video clip of basketball players who are on a court when one of them collapses. The clip posed the question, “Are you ready to help?” It then outlined three effective responses: call 911, begin cardiopulmonary resuscitation (CPR) and get an automated external defibrillator (AED). Olsen emphasized that quick attention gives the victim the best chance of survival.

Goodman reiterated the importance of key steps of care: early recognition and action, early and high-quality CPR, rapid defibrillation, advanced resuscitation, post-cardiac arrest care and recovery. Goodman said EMS objectives for SCA should include early, continuous, high quality chest compressions and maximizing the number of cardiac arrest patients who return home neurologically intact. She shared the case of a 22-year-old female who collapsed at a gym due to sudden cardiac arrest. Use of an AED played an important role in her successful outcome.

Papale told a riveting SCA survivor’s tale. In August 2006, he was a seemingly healthy 17-year-old and an aspiring basketball player. After an intense court workout, he went to a basketball camp where he was a counselor and “took a faceplant” while sitting on a bleacher. There was no AED available, but CPR was performed, 911 was called, and the ambulance crew resuscitated him on the way to the hospital. It turned out that Papale had a heart condition called hypertrophic cardiomyopathy (HCM), and he had to have a cardioverter-defibrillator implanted in his body. He learned to live with his disease and refocused his goals, especially after surgery he had in 2014 to change the implant battery that led to an infection and the need for open-heart surgery. He was lucky to survive.

Olsen explained that HCM is a genetic disease caused by a gene mutation characterized by an increase in the size of the left ventricle. The prevalence may be as high as 1 in every 200 people. Clinical manifestations can include chest pain and/or labored breathing with exertion, palpitations and heart murmur. Patient’s with HCM have a 1% annual mortality risk due to the development of a lethal arrhythmia. Olsen stressed to EMS providers in the audience the importance of obtaining a family history and recommended a number of diagnostic procedures: electrocardiogram, echocardiogram, exercise stress test, cardiac MRI and/or cardiac catheterization. For low-risk patients, he said, treatment includes close clinical observation for monitoring of symptoms and low-to-moderate levels of exercise. For high-risk patients, Olsen noted that an implantable cardioverter-defibrillator, as in Papale’s case, is the best available therapy.

Nolan reported that SCA is the leading cause of sports-related death in competitive athletes. Reported incidence has increased with approximately one case happening every four days in organized sport, and incidence is even higher among male athletes, African-Americans and basketball players. Survival increases with proper emergency planning and equipment.

Among high schools, 1 in 70 will have an SCA on campus, almost half of them athletes, said Nolan. If these incidents are spotted quickly and response preparation is in place, 85% of SCAs are survivable. Nolan notes that the challenge is getting states to adopt and enforce best practice recommendations, which includes employment of proper medical personnel such as certified athletic trainers. According to the most recent studies, only 48% of athletes who suffer a SCA are surviving. These studies also show that HCM and coronary artery anomalies are the most common causes of SCA, suggesting that more up-front screening is necessary.

Papale advocated screening young hearts with electrocardiograms (ECG) and patient follow-up for individuals identified as having an abnormal ECG, which he is working to implement through his nonprofit. Goodman also recommended collaboration across the continuum of care, routine SCA simulation drills, education and advocacy, to provide the highest success rate. 

The College of Health Professions Dean’s Speaker’s Series provides free, educational lectures to existing and potential students, faculty, alumni and community partners regarding relevant topics in today’s health care system. 

Photo caption: CHP Dean Maura Iversen (second from left) with panelists (from left) Adam Olsen, Leigh Goodman, Mike Papale and Julie Nolan.