Although adolescent sports-related deaths are rare, they are commonly caused by cardiovascular problems, such as commotio cardis--cardiac arrest caused by being hit in the chest with an object, such as a baseball or softball, usually traveling 30 to 50 miles per hour. The frequency of this problem is not known, but the survival rate is low among reported cases. However, the survival rate may be increased when cardiopulmonary resuscitation (CPR) is performed and an automated external defibrillator (AED) is used within three minutes of impact. An article in the December issue of The Journal of Pediatrics examines one report of how CPR training and the use of an AED can increase the survival rate for adolescents experiencing commotio cardis on the playing field.
Dr. Neal Thomas and colleagues from Penn State Children's Hospital, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, and Minneapolis Heart Institute Foundation reported a healthy 13-year-old boy who suffered cardiac arrest after being hit in the chest by a pitch while at bat in a baseball game. The coaching staff immediately began administering CPR, and 6-8 minutes later the paramedics arrived and used an AED. The boy was taken to the emergency room and was awake, talking, and following commands within one hour of his arrival; he was discharged from the hospital after three days.
Since 62% of cases of commotio cardis have been reported to occur during competitive sporting events, Dr. Thomas points out that "more effective first-responder therapy is needed." Timeliness, training, and equipment are all important aspects of delivering effective treatment. Although the average cost of an AED is $2,500, survival rates for commotio cardis may increase to 25% if resuscitative measures are taken within three minutes of impact; delayed efforts or CPR-only can reduce the survival rate to 3%. Chest protector equipment can reduce the risk of commotio cardis, but 28% of cases of commotio cardis occurred in spite of this protection. Dr. Thomas suggests that "communities and school districts reexamine the need for accessible AEDs and CPR-trained coaches at organized sporting events for children."
The study is reported in "Efficacy of bystander cardiopulmonary resuscitation and out-of-hospital automated external defibrillation as life-saving therapy in commotio cordis" by Erik A. Salib, DO, Stephen E. Cyran, MD, Robert E. Cilley, MD, Barry J. Maron, MD, and Neal J. Thomas, MD, Msc. The article appears in The Journal of Pediatrics, Volume 147, Number 6 (December 2005), published by Elsevier.
The Journal of Pediatrics is a primary reference for the science and practice of pediatrics and its subspecialties. This authoritative resource of original, peer-reviewed articles oriented toward clinical practice helps physicians stay abreast of the latest and ever-changing developments in pediatric medicine. The Journal of Pediatrics ranks 3rd of 70 pediatric journals receiving the most citations (Science Citation Index). The Journal is published by Elsevier, a leading global publisher of scientific, technical, and medical journals, books, and reference works. It is a member of the Reed Elsevier plc group. URL: www.jpeds.com
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