Supporting Families. Saving Lives.
By Stuart Berger, M.D. SADS Foundation Board Member (2/2010)
It is SADS' goal to prevent sudden cardiac arrest (SCA) and sudden cardiac death (SCD). Many prevention strategies have been suggested, some of which have raised controversies. In general, prevention strategies can be divided into primary prevention strategies and secondary prevention strategies. Primary prevention strategies imply screening in order to identify those at risk for SCA. This implies that identification of those at risk will allow for an intervention that will prevent a SCA. Secondary prevention strategies imply optimization of rapid and efficient intervention such that when an episode of SCA occurs, the intervention(s) will insure survival.
There have been a variety of primary prevention strategies that have been instituted. The most common and universally accepted technique is the "pre-participation evaluation" (PPE) although this discussion is by no means targeted to athletes and in fact should be extended to the general population of children and young adults. The PPE requires a careful and comprehensive targeted personal history, family history and physical examination as recommended by the American Heart Association (AHA). It is unlikely that the above approach will uncover all of those at risk as a subset of patients truly have no antecedent symptoms, have a negative family history and have a normal physical examination. However, retrospective studies have shown that anywhere from 20-40% of patients with SCD may have had antecedent symptoms including syncope. Additional screening with the use ECGs, though currently recommended for the European athletic population, is controversial in the United States. Although performed in some communities and recommended by some practitioners, the AHA has not recommended this strategy for mass screening. Several logistic issues must be solved including costs, manpower for evaluation of the studies, recommendation of appropriate normal values, as well as the variable incidence of false positives (and their implications and handling) before this recommendation can be adopted universally in the United States.
Secondary prevention is an additional important strategy in the prevention of SCD. Education of communities in the rapid deployment cardiopulmonary resuscitation (CPR) and the use of automated external defibrillators (AEDs) can save lives. Results of the adult public access defibrillation (PAD) trial, as well as multiple reports from casinos, the airline industry and schools suggest a survival advantage to CPR-AED programs compared to standard CPR alone. Such successes suggest that we should continue to advocate for this form of community education and that we should include our schools. The latter strategy has saved the lives of children and young adults as well as older adults.
SCA and SCD can indeed be prevented by a multiplicity of strategies, none of which are mutually exclusive. We look forward to much more work in the areas of advocacy and education as we go forward on our mission of life saving work. The future is very bright in the area of prevention.