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[NEWS BRIEF]

THE PHYSICIAN AND SPORTSMEDICINE - VOL 29 - NO. 4 - APRIL 2021


AEDs Gain Foothold in Sports Medicine

Publicly accessible automated external defibrillators (AEDs) were once found only on airlines and at other major public venues, but their resounding success at improving the odds of surviving a cardiac event (1,2) has propelled their use into more focused settings such as training rooms and sidelines.

The American Heart Association (AHA) recommends that AEDs be placed where a reasonable probability exists of one sudden cardiac arrest occurring every 5 years. Also, the AHA recommends that all whose jobs require that they perform cardiopulmonary resuscitation be trained to operate an AED (figure 1) (3).

The relatively new trend of having an AED in the sports medicine setting means that physicians are often entering new territory when it comes to establishing AED-related policies. (See "Automated External Defibrillators: Selection and Use," March 2021, page 112.) The US Food and Drug Administration requires a written request from a physician to obtain an AED. Atlanta cardiologist John D. Cantwell, MD, in recent years has instituted AED programs with the teams for whom he works: the Atlanta Braves and Georgia Institute of Technology. "More people are thinking about AEDs for spectators, coaches, and athletes," he says. "It's still pretty unusual for an athlete to require defibrillation, but AEDs are a good thing to have for emergency response."

Colleges Put AEDs Into Practice

Physicians whose teams have AED access recommend answering the following questions before obtaining the device: Who on the staff should be appointed and certified to use the device? Where should the device be located? Who should maintain the device? and What medicolegal issues might arise?

Cantwell says that in the Yellow Jacket and Braves training rooms, the AED is usually located where athletic trainers can obtain central access. "It usually travels with the team and is packed along with the other medical equipment," Cantwell says. (See "AED Trips a Canine Alarm," page 16.)

AEDs are becoming common fixtures in the college athletic setting. Mark J. Hudak, MD, athletic team physician at Kent State University in Kent, Ohio, says his department bought its first AED about 3 years ago. "It started with one unit in the main athletic facility, a field house, where a lot of seniors from the community come and walk on the track," he says. "For several years in a row we had someone collapse in there and die. So this was prompted by community service." The school placed other AEDs at a different training facility, at the student health service, and in the campus recreation center.

Hudak supervises the training of the athletic department staff members authorized to use the AED and is briefed whenever the AED is used for resuscitation. "The AED isn't part of my medical kit because I'm not at every event, but the trainers have it on the sidelines," Hudak says, noting that the AEDs do not travel with the teams. "It would be difficult to prioritize which teams would get them." The department's athletic trainers are responsible for maintaining the AEDs according to manufacturers' recommendations.

So far, there have been two AED deployments, Hudak says. A parent of a recruit was resuscitated in the field house, and an employee at the recreation center who was electrocuted did not survive.

Indiana University in Bloomington obtained three AEDs for its athletic department 2 years ago, says James P. Nevins, MD, the university's director of sports medicine and head team physician. The units are placed at each of the school's three main training facilities. He notes that 12 members of the athletic department staff are trained to use the AEDs.

Though Nevins was instrumental in obtaining the AEDs for the athletic department, he has reservations about the devices. "I'm glad we have the AEDs, and they do provide a comfort zone, but is this a gut reaction?" he asks. Sudden death is unlikely in a training room frequented by elite athletes who are in top physical condition, he notes. The AEDs are more likely to be used on coaching or support staff. "In one instance, a football referee had a cardiac arrhythmia, determined to be benign by paramedics, and did not need the AED," Nevins says. So far, the department's AEDs have not been used for resuscitation. "However, if one life is saved, that would make their presence extremely worthwhile."

Nevins wonders if AEDs in the sports setting represents a "cultural veil of overprotectiveness," and he wonders if perceived liability concerns are driving the AED trend. "I also wonder if the medical 'arms race' rather than common sense is dictating the standard of care," Nevins says.

Use In High Schools

Some high schools are starting to consider and buy AEDs. In Wisconsin, Project ADAM, a major effort to equip all the state's high schools with AEDs, was started by a teen whose friend died suddenly during a basketball game. Project director Stuart Berger, MD, director of the heart center at Children's Hospital in Milwaukee, says that death was one of seven cardiac episodes that occurred among adolescents in southeast Wisconsin within about 18 months.

Wisconsin schools that express an interest in buying an AED are offered fundraising help from Children's Hospital and other civic organizations. "Project ADAM also has an educational goal," says Berger: "to teach about screening and symptoms and about how to intervene with CPR if a cardiac event occurs."

So far about 40 Wisconsin high schools have bought AEDs, he says. AED policies seem to vary by school; some have more than one, some keep the device in a red box in the principal's office, and some transport the device to various school events.

Other states such as Oregon and Washington have contacted Berger about starting similar programs. "This is fairly easy to do," he says, because sudden cardiac death intervention is such a passionate issue. "We're trying to save the lives of a rare group of kids who are at risk for this," he adds.

Liability Concerns

According to the AHA, as of March 2021 all states except Delaware, Maine, North Carolina, and Vermont had adopted laws or amended Good Samaritan provisions so that laypeople are protected if they administer AED treatment. In November 2021, then-president Bill Clinton signed into law the Cardiac Arrest Survival Act, which extends protection to AED users in all states.

David L. Herbert, JD, a specialist in the legal aspects of sports medicine and a senior partner at Herbert & Benson in Canton, Ohio, says sports medicine physicians don't appear to be legally vulnerable because AEDs do not appear to be part of standard sports medicine care at this time. However, he urges physicians to remain vigilant about any sports medicine recommendations that are issued as well as new recommendations the AHA makes regarding placement of AEDs. He notes that some lawsuits have been brought against sites (ie, a health spa, an amusement park, and a health club) for failure to have an AED.

Lisa Schnirring
Minneapolis

REFERENCES

  1. Valenzuela TD, Roe DJ, Nichol G, et al: Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos. N Engl J Med 2021;343(17):1206-1209
  2. Page RL, Joglar JA, Kowal RC, et al: Use of automated external defibrillators by a US airline. N Engl J Med 2021;343(17):1210-1216
  3. American Heart Association: International CPR and ECC guidelines, part 4: the automated external defibrillator: key link in the chain of survival. Circulation 2021;102(suppl I):I60-I76


AED Trips a Canine Alarm

Last fall, the automated external defibrillator (AED) used by the Atlanta Braves created quite a stir when the team traveled to play the New York Mets.

John D. Cantwell, MD, an Atlanta cardiologist and a team physician for the Braves, recounts how the team and all its equipment had to pass a security clearance because of controversy surrounding Braves pitcher John Rocker. (Rocker's inflammatory comments had been widely quoted.) "Everything cleared, then our equipment started beeping, and the bomb-sniffing dogs went ballistic," Cantwell says. "It was the AED signaling that its battery was low."

The moral: When traveling, make sure AEDs are fully powered, especially around bomb-sniffing dogs.


Noteworthy

Howard G. (Skip) Knuttgen, PhD, received the Olympic Order from International Olympic Committee (IOC) President Juan Antonio Samaranch in a ceremony held in December in Lausanne, Switzerland. Knuttgen is a lecturer on physical medicine and rehabilitation at Spaulding Rehabilitation Hospital and Harvard Medical School in Boston. He is an editorial board member of The Physician and Sportsmedicine.

Knuttgen received the award in recognition of his 12 years as chair of the IOC Medical Commission's publications commission, according to a joint press release from Spaulding Rehabilitation Hospital and Harvard Medical School. He has also been instrumental in developing the world's most complete sports medicine and sports science collection at the Olympic Museum Library in Lausanne.


Field Notes

NHL Panel to Investigate Injury Increase
Increasing injuries in the National Hockey League (NHL) this season have caught the attention of league executives, who have formed a panel to investigate possible causes. The panel will begin its work after the season and meet several times over spring and summer 2021 before making its recommendations to the league.

Willem H. Meeuwisse, MD, PhD, Calgary Flames team physician who is, as chair of the NHL Team Physicians Society Injury Committee, an executive member of the NHL's Injury Analysis Panel, says that injuries have increased 26% compared with last season, and that most seem to be minor injuries. He says that the panel will sort out whether game- or equipment-related factors are responsible or if reporting differences are the cause. He notes that though injuries are up, player-games lost are down. "That's encouraging," he says.

Meeuwisse is one of the founders of a Web site (www.hockeyinjuries.com) that tabulates NHL injuries throughout the season. The site offers a comprehensive listing of the latest hockey-related reports in the medical literature as well as injury prevention and treatment information for players, coaches, parents, and athletic trainers. The content of the site is reviewed by the Canadian Academy of Sport Medicine.

Sudden Cardiac Deaths Up in Young People
The number of adolescents and young adults who die from sudden cardiac arrests is rising, according to a study of death certificates among those ages 15 to 34 presented in San Antonio in February at the American Heart Association's (AHA) Annual Conference on Cardiovascular Disease Epidemiology and Prevention.

According to an AHA press release, the yearly death totals for this age-group rose about 10%—from 2,719 in 120219 to 3,000 in 1996. Though the rate of sudden cardiac death was twice as high in males as in females, the rate for girls and women rose 30% over the study period compared to a 10% rise among boys and men.

Zhi-Jie Zheng, MD, PhD, lead author of the study and an epidemiologist with the Centers for Disease Control and Prevention in Atlanta, says that the trends in young people require more study. "But we can speculate that some of the increase may be related to the increased prevalence of cardiovascular risk factors such as obesity among adolescents," he says, adding that poor rates of recognizing sudden cardiac death and applying cardiopulmonary resuscitation may also contribute to the rise.

Death certificates examined in the study showed that 36% suffered from ischemic heart disease and 34% had an arrhythmia or cardiomyopathy.

African-American Women and Eating Disorders
African-American women aren't immune to eating disorders, according to two University of Missouri, Columbia researchers who published a survey of 413 African-American college women in the January issue of the Journal of Counseling Psychology.

A press release from the university notes that researchers found that the prevalence of eating disorders in African-American college women is similar to that found among their Caucasian peers: 2% have an eating disorder and 23% sometimes have symptoms of an eating disorder.

The difference between the two groups is the type of eating behaviors reported. African-American women interviewed for the study said that thin women are often considered unattractive in their culture, and that some intentionally gained weight by binge eating.

The press release says that the study is the first to examine the prevalence of eating disorders in African-American college women, and that the findings are important because they dispel a myth among health professionals that eating disorders are only a problem among white women. The researchers urge healthcare professionals to be aware of various cultural perceptions of beauty and to help women understand the risks of binge eating.

Some Magnetic Pain Relief for Fibromyalgia Patients
In one of the first clinical studies of magnet therapy for pain, University of Virginia researchers found that though the results of their study involving fibromyalgia patients were generally inconclusive, one of the study groups had a pain decrease that was considered clinically significant. The study, partially funded by the National Institutes of Health, appeared in the February issue of the Journal of Alternative and Complementary Medicine.

According to a press release from the university, three pain measures in the study included functional status, number of tender points, and pain intensity. Ninety-four fibromyalgia patients were randomly divided into four groups. One control group received mattress pads containing demagnetized magnets and the other control group received their usual fibromyalgia treatment. The intervention groups received either mattress pad A, which provided whole-body exposure to a low, uniform, static, negative-polarity magnetic field or mattress pad B, which provided varied exposure to a low, static magnetic field. (The magnetic fields of the mattresses were tested to quantify magnetic exposure.)

Researchers found no statistical differences in most of the outcome measures; however, the group that had pad A had consistent, statistically significant improvements in all outcome measures at 3 and 6 months. Improvements seen at 3 months for patients who received pad B were maintained at 6 months.

The researchers state that final conclusions shouldn't be drawn from one study. They also note that, based on the popularity of magnets as a treatment for fibromyalgia, tennis elbow, carpal tunnel syndrome, and other types of musculoskeletal pain, more research is needed to find clear answers about magnets' safety and efficacy.


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