In this insightful discussion, Zian Tseng, a Professor of Medicine at UCSF and leading authority on cardiac arrest, shares crucial insights about sudden cardiac arrest in young adults. He reveals staggering survival rates, emphasizing that only a small percentage of out-of-hospital cases result in discharge. The conversation dives into the varying causes of these incidents, the vital role of screening for families, and the careful management needed for athletes wishing to return to sports after such events. Mental health support for survivors is also highlighted.
Out-of-hospital cardiac arrest in healthy young adults has a low survival rate, with only 9% to 16% surviving to hospital discharge.
Understanding the diverse causes of cardiac arrest, including non-cardiac factors, is essential for effective diagnosis and prevention strategies.
Deep dives
Survival and Neurological Outcomes in Cardiac Arrest
Approximately 90% of young adults who survive cardiac arrest are discharged with good neurological outcomes, measured through the cerebral performance category scale. However, it's crucial to recognize that many patients do not survive after an out-of-hospital arrest. Autopsy studies indicate that nearly 40% of victims of out-of-hospital cardiac arrest have non-cardiac underlying causes, such as drug overdoses or neurological conditions. The predominant cardiac causes include coronary disease and sudden arrhythmic death syndrome, highlighting the complexity of cardiac arrest cases in typically healthy individuals under the age of 40.
Comprehensive Evaluation Following Cardiac Arrest
A thorough evaluation is necessary for survivors of cardiac arrest to determine the underlying cause. Initial steps should include a broad differential diagnosis, starting with an electrocardiogram and subsequent imaging to rule out structural issues. Neurologic imaging and laboratory tests to address conditions like hypokalemia or hypomagnesemia are also vital during the assessment process. If reversible causes are excluded, further investigations such as echocardiograms and possibly genetic testing for hereditary conditions become crucial in guiding prevention strategies for future cardiac events.
Screening and Management in Young Athletes
When considering young athletes, the incidence of sudden cardiac death is relatively low, leading to a shift towards shared decision-making regarding their return to competitive sports. While certain high-risk activities, like intense sprinting, may warrant restrictions, moderate exercise is generally encouraged to maintain cardiovascular health. For siblings of cardiac arrest survivors, clinical evaluations and genetic testing should be conducted if a specific cause is identified. Controversies exist regarding routine ECG screenings in asymptomatic individuals, with guidelines in the U.S. differing from those in Europe, emphasizing the need for optimal screening practices to prevent cardiac events.
Out-of-hospital cardiac arrest in apparently healthy adults younger than 40 years ranges from 4 to 14 per 100 000 person-years worldwide. Among young adults who have had cardiac arrest outside of a hospital, only 9% to 16% survive to hospital discharge. Author Zian Tseng, MD, MAS, University of California, San Francisco, discusses this and more with JAMA Associate Editor David L. Simel, MD, MHS. Related Content: