Cardiac Arrest in young people is real - but not the way that "sudden death" fear-headlines tell it. What parents need to know.
You may have seen headlines recently, noting a “database” of over 1,500 cardiac arrest / “sudden death” in young athletes in the last year alone, and then comparing this to an average of 29 cardiac arrests per year, from 1966-2004.
After seeing Damar Hamlin collapse, as well as a number of other notable people in the last few months who ostensibly were in the “prime of health”, it’s entirely normal to have wanted answers.
What’s happening? Why does it feel like we are suddenly seeing so many seemingly healthy people collapse?
As an ER doctor, I’ve taken care of patients like Hamlin. As a patient, I have nearly gone into cardiac arrest (and had to be shocked, like Hamlin was on the field). So, this was professional. And it was personal.
Two really important concepts here:
- This article is a total farce (see examples below)
- Cardiac arrest in young people is a REAL thing. As an ER doc and mom, and after hearing your scared questions, I realized that we MUST talk about this. You NEED to know how to reduce the risk for yourself, and your children.
With that, let’s dive in.
TL;DR
(read ON below FOR Full Report)
Sudden Cardiac arrest is NOT a new entity – it kills approximately 550 5-24 year olds in the United States per year.
- Why the fear-based headline was wrong:
- They drastically under-estimated the number of cardiac arrest deaths pre-COVID. It’s not 29 / year, in the US, it’s closer to 30-80 deaths / year in sports, and an estimated 2,100-2,800 deaths from cardiac arrest per year in everyone in the 5-35 year age range.
- Their list of people who “had cardiac arrest” in the last year would be laughable, were the topic not so grim. It includes someone who committed suicide with a gunshot to the head, multiple people who had cancer, many people 65 and older, and very incomplete mention of vaccination status.
- From speaking with experts, even though the 2022 data has not been finalized, there has NOT been any drastic increase in cardiac arrest in athletes in the last year (and there was not in 2021).
- NO, the vaccine is NOT adding to any bump in cardiac arrests (see my full post on that here).
- Given how cardiac arrest DOES happen – and that it has a less than 50% survival rate, it’s CRUCIAL that we ALL start to talk about this – both for ourselves, and our children. Key ways to mitigate your risk:
- Consider regular EKG screening of children who play sports, starting at age 12. (The primary reason that this isn’t recommended in the US, is because we don’t have the infrastructure and enough people who are trained to read these EKGs. I think that needs to change)
- Advocate for AEDs at EVERY sporting site
- Know where the AED is, and how to use it, and be trained in CPR.
Want to see the evidence? Read on.
Full Report
Definitions
- A note on the data: information on deaths is typically delayed by about 6 to 8 months, to ensure accuracy. We don’t have full 2022 data yet. For the most recent 2022 data, I went to experts intimate with the data itself, and will update this document as data is released (probably starting in March 2023).
- What IS “Cardiac arrest”? You hear this thrown around – and in reality, it’s a grab-bag of conditions, not a single entity.
- Sometimes, it refers to a very specific subtype of “Sudden Cardiac Arrest” (SCA), where someone appeared previously healthy, then collapsed suddenly due to something that went wrong specifically in their heart.
- But Cardiac Arrest also can be much broader – because essentially in the end, everyone dies because their heart stops – i.e. “Cardiac Arrest”.
- Someone had septic shock that caused their blood pressure to become so low that it could not maintain blood flow to the arteries of the heart, the heart tissue died, and eventually the heart stopped pumping? Cardiac arrest.
- Someone was born with a clotting disorder and developed so many clots in their lungs that their heart was unable to function well and stopped working? Cardiac arrest.
- Someone had a motor vehicle collision that caused a massive hemorrhage to collect in the small sac around the heart and impeded any blood flow? Traumatic cardiac arrest.
- Someone was born with a congenital heart problem that caused their heart to stop beating appropriately. Cardiac arrest.
- Someone overdosed on heroin, stopped breathing, and their oxygen levels got so low that no oxygen was going to their tissues? Cardiac arrest.
- Someone has a ruptured brain vessel aneurysm, that leads to a massive hemorrhage, which caused an increase in intracranial pressure, pressing on the brainstem, leading to them stopping breathing and low oxygen? Cardiac arrest.
- See where I’m going? “Cardiac arrest” can mean anything. So much that, many states don’t actually allow doctors to put “Cardiac arrest” on the death certificate anymore, because they want us to be more specific about the actual cause.
For clarity today, I’ll the term these terms:
- “Sudden Cardiac Arrest” (SCA) to mean conditions that occur when someone was seemingly totally fine, and suddenly collapsed due to a problem intrinsic to their heart – whether they died or not
- “Sudden Cardiac Arrest Death” (SCAD): someone who had an SCA and died from it.
How often does cardiac arrest actually happen in young people?
The headline I mentioned above, said that there were 29 cardiac arrest deaths / year, prior to COVID. Here’s why that was incorrect.
While rare, sudden cardiac arrest (SCA) is not new – it’s vexed us physicians for decades and led to heightened attention (and creation of registries to track them) since the early 2000s.
On average, in the United States over the last 20 years, it occurs: (numbers are averaged from a variety of sources, including the total census, and incidences in this and this paper)
| Age | # SCA / year | # Deaths / year | Incidence |
|---|---|---|---|
|
5-14 years |
250 |
150 |
0.61/100,000 people |
|
15-24 |
600-700 |
~400 |
1.4/100,000 |
|
25-35 |
2,000 |
1,200 |
4.4/1,000 |
Specific populations: (based on various studies)
- Note: These are based on actual case reports, so they’re felt to be a vast underestimate – per Dr. Jonathan Drezner, Co-PI of the Outcomes Registry for Cardiac Conditions in Athletes, Professor at the University of Washington, and avid reseacher in this area, the are anywhere by 50% of actual cases.
- FIFA: globally, recorded 617 deaths in 4 years, meaning 150 known deaths per year during (or 1 hour immediately after) playing soccer per year, from 2014-2018
- Middle, high school, college, and pro sports: 30 to 80 sudden cardiac arrests and deaths / year in the United States (2014 to 2018)
- Military: 3 to 7 per 100,000 people
- NCAA: 45 cardiovascular-related deaths between 2004 and 2008, reaching an incidence of 1/43,770 players per year. Highest in male NCAA division 1 basketball players, which reached 1/3,100 per year
- Risk is significantly greater in males than females
Are rates of cardiac arrest actually increasing?
Ok – first, let’s go back to debunking that fear-based headline. They noted. “over 1,500 athletes who went into cardiac arrest” in the last year alone. Turns out that most of them were neither young, nor athletes. Some examples
- 27 year old sprinter, died mysteriously…ruled suicide by self-inflicted gunshot to the head. Was he vaxed and if so, did he know his career was over? ( This is such a stretch).
- 16 year old male – hockey player. He developed myocarditis from COVID-19. Neither Beau nor his family mentioned being vaccinated in the story. (ummm….he got myocarditis from COVID. Not the vaccine. Also he’s not dead).
- 26 year old footballer had been suffering from leukemia. His condition worsened and he died. (he had leukemia! People die from leukemia).
- 24 year old footballer. Had COVID and now has myocarditis, and is unable to play. (Yep. And he’s not dead, either)
- 49 year old male. He died in the hospital of liver disease.
- 31 year old male. He died of cancer.
- 62 year old male. Died “after a brief battle with cancer”.
I will stop. Hopefully at this point, you’ll no longer worry about this headline – and be armed to drop some data bombs on the next soul that mentions it to you. (I’ve put even more examples at the bottom of this post).
So, what’s the truth? Are deaths from Cardiac Arrest increasing in youth? Yes – and No. Death from pretty much ALL causes has increased since 2014 – so in a global sense, yes. More Americans are dying, period. However, there is NO drastic “bump” in cardiac arrest in young people (particularly not in athletes). Let me explain.
While in the US, we were reducing mortality from all causes in the early 2000s, in the 2010s that trend started to reverse. Suddenly, we started seeing an increase in all-cause mortality in ALL ages – especially so in younger people. That trend then jumped in 2020 with the onset of COVID. The trend reversal appears to have been hugely driven by external factors rising (trauma, overdose, suicide, drowning, firearms), as well as chronic disease, and consequences of alcohol abuse. (I’ve written far more about this here).
So, YES – as all causes of death rose, so did cardiac arrest rates, in general.
Looking specifically at out-of-hospital cardiac arrest rates (meaning ALL calls to EMS for people who collapsed, which is different from SCA), they have shown a similar slow trend up, with a large jump in 2020, according to the CARES Network database and also founder Dr. Bryan McNally).
BUT – while the rates of cardiac arrest are up, the ratio by age and gender has not changed, meaning that there is NO drastic bump in young people.
What about cardiac arrest in athletes?
One caveat here: we do not have finalized data for 2022. A number of entities will be formalizing that data in the next 2 to 4 months. When those come out, I will update this document.
To get an estimate, I spoke with Dr. Jonathan Drezner again, as he’s intimately aware of the data. He noted that while they have not yet published their data for 2022, “I have reviewed the data and have not seen ANY unexpected or significant change in the rate of sudden cardiac arrest in athletes in the last 14 months”.
What causes cardiac arrest in young people?
- What age does it occur?
- According to a study from 2020 by Dr. Jonathan Drezner and other researchers, the average age was 16.7 years
- Most common causes:
- Hypertrophic and other cardiomyopathies
- Idiopathic left ventricular hypertrophy
- Coronary artery anomalies
- Arrhythmogenic (Wolf Parkinson White, Brugada, Long QT)
- According to the National Center for Catastrophic Sport Injury Research, in 2021, 47% of these events were fatal. Which is why screening is important.
- Do they have symptoms? Not necessarily. In fact, up to 71% of athletes who died had no symptoms prior to their event.
- What happened with Grant Wahl? Putting this here, as there are questions about this as well. However, Grant Wahl’s death does not fall under “SCA” – because, as his wife shared, he died from “the rupture of a slowly growing, undetected ascending aortic aneurysm with hemopericardium.” This diagnosis is one that is often clinically silent, until it actually ruptures. While this is most commonly a diagnosis in the 60s and up, it absolutely can happen at younger ages, with risk starting to slightly climb as early as 30 years. (And, while related, this is a different diagnosis an “aortic dissection”, which killed such celebrities as John Ritter, Jonathan Larson (the creator of the musical RENT), and Alan Thicke).
What should you do to lower the risk of SCA and SCAD in your family – and even yourself? 5 things.
- KNOW where the AEDs are. The #1 predictor of survival after SCA? Time to shocking with an AED. Damar Hamlin had his shock within minutes of collapsing. But do you know where the AED is for your child’s (or your own league’s) soccer game? If not, find out.
- Encourage all sports facilities to have an AED – at any site. Whether it’s a varsity game or just a club sport, all facilities need these on-hand.
- Make sure you know how to use an AED. It’s REALLY simple. You place the pads, turn the thing on, and it tells you what to do. Don’t be scared of these. You can do this. Take a CPR refresher course (via the AHA or Red Cross), which will teach you AED use as well.
- Consider EKG screening all athletes, especially males. Most groups (AHA, AAP) agree that athletes should have a screening physical exam and family history, as well as a questionnaire. But that’s where the agreement ends – MANY groups disagree on whether or not athletes should also have an ECG. The European Society of Cardiology / European Heart Rhythm Association DOES recommend an EKG along with the traditional screening method, and Dr. Drezner said that “In an ideal world, we’d screen every athlete at age 12, and every 2 or so years thereafter”. The challenge here? Having enough physicians who are expert at interpreting an athlete’s EKG to screen for the rare but deadly conditions. Some groups are working to increase education here. For now, if you would like to have your child screened, look for a specialist in pediatric cardiology or sports medicine, to have an EKG performed.
- If you see an athlete collapse, check immediately for SCA. As Dr. Jonathan Drezner told me, “If a child or young adult collapses on the field, expect cardiac arrest until proven otherwise”. What does that mean? It means be prepared to perform CPR. Do a quick pulse check, and if there is no pulse, start CPR.
- Pay attention to lifestyle. As age rises above 30, one of the biggest drivers of SCA is heart disease. We will only reverse this trend, when we reduce the prevalence of diabetes, heart disease, and associated risk factors.
Yes, this is a terrifying thing. But it’s one that by taking these steps, we can protect our families and communities. It’s time.
Warmly,
- Dr. Darria
PS: Could the COVID-19 vaccine have contributed to cardiac arrest?
I think it’s a fair question for anyone to ask, after seeing the headlines – and I also think us physicians need to step up and answer that. However, after digging into the data (read the full blog report here), I’m very comfortable saying that NO, the COVID-19 vaccine has not contributed to cardiac arrest. See my full post and explanation on the details, and additional pieces for young men and parents of young men to understand.
Appendix:
Examples of the recent headline list of “young athletes who died from cardiac arrest”
- 24/12/2022 Uruguay Dead
Fabian O’Neill (49), Juventus Football player with clubs in Uruguay and Italy. He died in hospital in Uruguay of liver disease. News Story News Story2 News Story3 - 22/12/2022 Brazil Dead
Luiz Ribaldo (56), Footballer and physical education teacher in Brazil. For 20 years, he has dressed as Santa Claus to entertain children and while preparing to appeared to the children, he had a cardiac arrest and died. News Story News Story2 News Story3 - 21/12/2022 Georgia, USA Dead
Ronnie Hillman (31), former Denver Broncos American Football player died of cancer. News Story News Story2 News Story3 News Story4 - 15/12/2022 Ohio, USA Dead
Louis Orr (64), former New York Knicks Basketball player then coach died of cancer at his home in Ohio. News Story News Story2 News Story3 - 10/12/2022 Newfoundland, Canada Dead
Gary Tiller (62), Curling player who represented Newfoundland province. He died after a “brief battle with cancer.” News Story News Story2 News Story3 - 08/12/2022 New South Wales, Australia
Leigh Holland-Keen (34), weightlifter suffered a cardiac arrest and had surgery to remove a 1kg tumour that was restricting her main heart artery. She survived and is back in training in the gym. News Story News Story2 - 21/02/2022 Honduras
Percy Castro (26), Arsenal de Cantarranas Footballer collapsed mid-football match at Juan Ramón Brevé stadium against Juticalpa FC, unable to breathe properly. Doctors said it was caused by an “unfortunate” blow (perhaps they mean accidental blow) from an opponent. News Story - 20/02/2022 England Dead
Steve Black (64), Newcastle Falcons Rugby & Football coach had coaching and training roles with football and rugby teams in Newcastle, England, as well as international rugby union with New Zealand. He died. Awaiting further details. News Story News Story News Story - 12/02/2022 Italy
Nicola Basile (39), Avis Capaci Futsal player in Sicily, collapsed to the ground possibly due to an aneurysm during a match and is now in serious condition. He underwent two head surgeries. News Story
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