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Sudden Cardiac Death: past, present and future
Editors: Sandra B Dunbar, Kenneth Ellenbogen, Andrew Epstein
American Heart Association Monograph 1997
"Sudden, unexpected, premature, arrhythmic cardiac death is always a triple tragedy when it occurs – a tragedy for the individual, for the family, and for the medical profession for having failed to prevent the sudden death" preface pg vii
Chapter 1: Sudden Cardiac Death: magnitude of the problem
"Up to 50% of deaths in patients with congestive heart failures are reported to be sudden" pg 1 (defined here as death within 1 to 24 hours of symptom onset)
"Ventricular fibrillation is the rhythm initially documented by rescue personnel in 65% to 85% of out-of-hospital cardiac arrests" pg 2
‘The risk of sudden cardiac death after myocardial infarction is highest in the first year.." pg 2
"Autonomic nervous dysfunction is believed to facilitate sudden cardiac death. Although there is compelling evidence for this association, the mechanism by which it occurs is as yet unclear" pg 5
‘Sudden death during sporting activities has been reported as early as 490 BC with the dramatic, unexpected death of the Greek soldier Pheidippides after his run from Marathon to Athens to deliver the news of victory over the Persians." Pg 8
Chapter 2: Epidemiology of Sudden Cardiac Death
Chart of Sudden Death events/year in the US from a 1989 publication
300,000 Overall incidence in adult population
220,000 High Coronary risk sub-group
180,000 Any prior coronary event
130,000 E.F (ejection fraction) < 30% heart failure
40,000 Out-of-hospital cardiac arrest survivors
20,000 Convalescent phase VT/VF after myocardial infarction
Chapter 9: Use of Heart-Rate Variability in Special Populations
"SIDS (Sudden Infant Death Syndrome) is the most common cause of death in children between the ages of 1 month and 1 year in the Western industrialized countries. It has been defined as ‘the sudden death of any infant or young child which is unexpected by history and in which a thorough post-mortem examination fails to demonstrate an adequate cause of death’" pg 179. The chapter goes on to show that of 5 studies (1986-1990) of Heart Rate Variability and SIDS, 3 found an association. This included a total 68 SIDS. None of the studies used the advanced Heart Rate Variability analysis techniques used with adults (which the Skyaid Watch will be able to use). Need better data!
The SIDS rate in the US is 2 per 1,000 live births. pg 180
Chapter 14 CPR Training for Families of Patient at High Risk for Sudden Death
Strange: rapid bystander CPR is least likely to occur in the victim’s home, but 3/4 of sudden death happen in the home in the presence of family members. Pg 258. While "family members of patients with documented cardiac disease may be the most appropriate target for CPR training, researches have shown that there are the least likely to attend a community CPR class." Pg 258. A study of CPR classes found that only "5.6% of students enrolled because they have a relative with cardiac disease"
Only 6% of clinicians recommend CPR to cardiac member families due to worry
that
1) they may not be able to learn CPR,
2) they may use it inappropriately during an emergency, and
3) they may feel inappropriately burdened by the responsibility that it entails.
The recommendations from the chapter include:
1) CPR for family members needs
to include social support to buffer the negative
effects of learning CPR,
2)
one-person CPR should be taught,
3) Adapt to special needs of elder learners