Secondary prevention of sudden cardiac death: does it work in children?

PURPOSE OF REVIEW: Over half of young sudden cardiac arrest victims show no prior warning signs or symptoms and survival depends on secondary prevention, notably prompt initiation of cardiopulmonary resuscitation (CPR) and the use of an automated external defibrillator (AED), for out-of-hospital arrests. There is increasing public interest in and uptake of public access defibrillation programs in communities and schools. Our purpose was to review recent data on sudden cardiac arrest in children and its outcome to identify ways to improve the current low survival rate of youth who experience sudden cardiac arrest. RECENT FINDINGS: Increases in bystander cardiopulmonary resuscitation in Norway to 73% have occurred alongside increasing survival from sudden cardiac arrest from shockable rhythms to 52%. Studies in Denmark and the US show that survival of 69-74% is possible when a shockable rhythm is present and an automated external defibrillator is immediately applied. Up to 70-80% of US schools have automated external defibrillators, but not all have effective emergency action plans to maximize the impact of the presence of the AED. SUMMARY: Studies suggest that education to increase bystander CPR and implementation of school AEDs and other public access defibrillation programs improve the survival of youth experiencing sudden cardiac arrest to 74% when optimal programs are in place. Methods to enhance such programs are presented. All involved with the health and education of youth are urged to implement best practices to protect youth and improve survival from sudden cardiac arrest.

Innovative cardiopulmonary resuscitation and automated external defibrillator programs in schools: Results from the Student Program for Olympic Resuscitation Training in Schools (SPORTS) study.

BACKGROUND: Bystander cardiopulmonary resuscitation (CPR) rates are low. Our study objective was to encourage Philadelphia high school students to develop CPR/AED (automated external defibrillator) training programs and to assess their efficacy. The focus was on developing innovative ways to learn the skills of CPR/AED use, increasing willingness to respond in an emergency, and retention of effective psychomotor resuscitation skills. METHODS AND RESULTS: Health education classes in 15 Philadelphia School District high schools were selected, with one Control and one Study Class per school. Both completed CPR/AED pre- and post-tests to assess cognitive knowledge and psychomotor skills. After pre-tests, both were taught CPR skills and AED use by their health teacher. Study Classes developed innovative programs to learn, teach, and retain CPR/AED skills. The study culminated with Study Classes competing in multiple CPR/AED skills events at the CPR/AED Olympic event. Outcomes included post-tests, Mock Code, and presentation scores. All students' cognitive and psychomotor skills improved with standard classroom education (p<0.001). Competition with other schools at the CPR/AED Olympics and the development of their own student-directed education programs resulted in remarkable retention of psychomotor skill scores in the Study Class (88%) vs the Control Class (79%) (p<0.001). Olympic participants averaged 93.1% on the Mock Code with 10 of 12 schools ≥94%. CONCLUSION: Students who developed creative and novel methods of teaching and learning resuscitation skills showed outstanding application of these skills in a Mock Code with remarkable psychomotor skill retention, potentially empowering a new generation of effectively trained CPR bystanders.