High-profile cases highlight issue of cardiac arrest in young athletes

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With a string of cases involving well-known stars and the spread of the issue on social media, sudden cardiac arrest in young athletes has been a topic garnering headlines lately.

The year began with the traumatizing cardiac arrest suffered by Buffalo Bills defensive back Damar Hamlin – where he was brought back to life on the field after taking a vicious hit to the chest that caused his heart to stop.

Then, last month, Bronny James, the son of NBA legend LeBron James and a freshman basketball player at University of Southern California, suffered cardiac arrest and collapsed during practice. He, too, was revived following quick action by the Trojans’ training staff.

Sudden cardiac arrest is a leading cause of death in young athletes with between 100 and 150 athletes succumbing each year, according to the American College of Cardiology. But it is still rare — the chances of sudden death occurring to any high school athlete are about 1 in 200,000 per year.

“The good news is that it’s not that common, but it certainly does happen,” Dr. Jeffrey Lander, co-director, Sports Cardiology at RWJBarnabas Health and co-medical director of the Cardiac Care Unit at Cooperman Barnabas Medical Center, told NJBIZ. “As we see on the news – Bronny James, Damar Hamlin, and some of these big-name folks. But also here in New Jersey, there have been several cases of young athletes who had cardiac arrest. The number is actually quite variable. It varies a lot by age, gender, ethnicity, sport actually – even level of sport. In general, in high-level competitive athletes, put it somewhere in the range of about one to two [cases] per 100,000 athlete years.”

Lander said that causes can include a structural abnormality in the heart, an electrical issue with the heart or something external, like taking a big hit as Hamlin did. He also addressed some of the discussion that emerged from the pandemic suggesting that COVID vaccines led to more cases of myocarditis – an acute inflammation of the heart muscle (usually from a virus) – in young athletes.

“You want to make sure to get the right information out there. In regard to COVID and the vaccine – yes, they have both been shown to cause myocarditis, which can cause heart complications, cardiac arrest,” said Lander. “It’s very uncommon that that happens. For example, in looking at a young, generally healthy athletic population, it’s much more likely to get very sick from COVID than it is to have myocarditis from the vaccine – much more common.”

Lander did note an uptick in engagement on the topic.

“Definitely since COVID, there has been much more of a discussion, which I think is a good thing,” he said. “I’m always happy to have these discussions. And I think athletes and parents should know going into sports – pros, cons, risks, benefits.”

Some of the work undertaken by RWJBH and the associated Matthew J. Morahan III Health Assessment Center for Athletes has included seminars and educational programs for parents, athletes, coaches and trainers to raise awareness and help guide them through the information process.

On the issue of cardiac screenings and how important they are for young athletes, Lander said we are lucky here in New Jersey to have Janet’s Law, which requires all school athletes to have a pre-participation examination.

“And it’s very important for the athletes to have pre-participation history and physicals for many reasons,” said Lander. “Not just for looking for potential underlying cardiac issues that may be dangerous to participate in sports. But it also affords us the opportunity to evaluate young athletes who may not have been evaluated otherwise.”

Janet’s Law also requires that any school-sponsored athletic event or team practice in New Jersey public and nonpublic schools have the following available: an automated external defibrillator in an unlocked location on school property within a reasonable proximity to the athletic field or gymnasium. In addition, a team coach, licensed athletic trainer, or other designated staff member if there is no coach or licensed athletic trainer present, must be certified in CPR and the use of AED; or a state-certified emergency services provider or other certified first responder must be on hand.

“I can’t emphasize enough how important it is it to have an emergency action plan, to have something in place to know what to do if, unfortunately, something bad happens,” Lander explained. “To have those trainers, coaches, parents, these athletes themselves trained in CPR and how to use AED. Again, in New Jersey, we’re lucky – just relating it back to Janet’s Law again.”

And of course, the American public watched an effective emergency action plan in real-time as trainers and emergency staff saved Hamlin after his heart stopped during that January game in Cincinnati.

He added that watching the Hamlin emergency play out placed an even greater emphasis on having a proper emergency action plan in place. “There’s definitely an uptick in questions of what can we do. How do we prevent this? What do we do going forward,” said Lander. “Having a trained individual in CPR, how to recognize an AED, an emergency action plan – are all super, super helpful.”

As for other tips and recommendations for raising awareness and improving cardiac health for young athletes?

“The big things I would say are before participating – see your physician, see your health care provider,” said Lander. “If you have a symptom, whether it be something really obvious or subtle – pay attention. Don’t ignore it. If it’s happening in the moment, sit down, relax, and bring it to the attention of your coaches and trainers, who may then escalate it to the physicians, if needed. And again, I always encourage athletes, coaches, parents to get trained in CPR. Know how to do CPR just in case the need arises.”

And Lander again stressed that he tries to educate athletes and their parents about these types of issues, but also noted that most competitive athletes are in touch and in tune with their bodies.

“They know that when they just, for some reason, can’t get to that next level or they feel like they were lagging behind their typical baseline or lagging behind their teammates,” Lander explained. “And they’re just not sure why. These are some of the more subtle things. And we point out and say listen, ‘bring it to the attention of your trainers, your coaches, your physicians.’ Because there may be something going on that’s causing that – that hopefully we can get to that early and prevent something from happening.”