Summer school classrooms are humming with activity on college campuses across the nation and soon, so will sports fields full of student athletes returning for training camps and practices.
But before they do, the National Collegiate Athletic Association’s top medical chief is reminding head athletic trainers and team physicians about a rare, but important concern of theirs: sudden cardiac death.
In a memo, Brian Hainline, M.D., provides a reminder of significant recommendations the NCAA made this spring about pre-participation health screenings for athletes – and the need to bolster emergency response plans to ensure quick and potentially lifesaving responses to students who experience sudden cardiac arrest.
The condition contributes to between five and 10 deaths in NCAA athletes every year. According to the most recent statistics from the American Heart Association, about 88 percent of cardiac arrest cases that happen outside of a hospital result in death.
The primary goal as college teams prepare for the upcoming sports season is to get everyone focused on cardiovascular care during pre-participation exams, Hainline said.
That means for most institutions, “nothing radical is going to change,” because they already assess an athlete’s personal and family cardiovascular history and adhere to a 14-point evaluation recommended by the American Heart Association.
But Hainline said the NCAA wants a “heightened consciousness” to ensure well-rehearsed emergency protocols are in place should an athlete go into cardiac arrest, regardless of the scenario.
“There’s a big difference between treating sudden cardiac arrest during football or basketball practice when there are only a handful of people around, versus a basketball game with 20,000 people, or a football game with 90,000 people, and the access points aren’t easy to get to,” he said.
The Journal of American College of Cardiology released the NCAA recommendations in April as part of a consensus statement, the result of work conducted over the past two years by a task force of cardiovascular and sports medicine experts, trainers and others with interests in college athletics.
The task force also included medical associations, including the AHA, which applauded the NCAA for convening the task force and “assuming a stronger leadership role in fulfilling its mission, which among other things, is to safeguard the health and wellbeing of student athletes,” said AHA’s chief medical officer for prevention, Eduardo Sanchez, M.D.
“This was about stepping up and saying, let’s bring key folks together and figure out if there are some things we can be doing better,” he said. “I’m not suggesting anything was done improperly, but in the world of quality improvements, when you bring around a bunch of physicians and health professionals and researchers, it is all about how do you move the needle and get even better.”
The NCAA in its recommendations also emphasized increased awareness about signs of cardiac arrest and training among coaching staff in administering CPR and using AEDs, or automatic external defibrillators. “This awareness and training creates a culture of action that prepares and motivates bystanders to respond immediately upon witnessing a cardiac arrest,” according to the consensus statement.
However, routine, widespread use of electrocardiograms was not listed among the recommendations, although the NCAA did provide specific guidance to schools already using them.
Hainline noted that sports cardiology is highly specialized and a relatively new field, making it difficult for many schools, particularly the smaller ones, to find doctors who have the expertise and experience to accurately interpret ECGs in student athletes.
“The knowledge base is a heck of a lot better than it was three years ago, but it’s still not good enough,” he said.
However, the NCAA task force did recommend establishing regional referral centers where cardiology oversight and experts can help interpret ECGs, particularly those with questionable results, and provide guidance on the heart health of student athletes.
Sanchez said it may be too early to see what kind of influence that the recommendations will have on athletes.
“But on the other hand, it does have an impact because now there’s something out there. There’s a blueprint. There’s a benchmarking document against which we can say, ‘How are we doing?’” he said. “Next year at this time we can have a good conversation about how we did this past year as it relates to the document. But it will be a work in progress.”