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I+Compress

Industry +  Centers  fOMass Practice and  Readiness  Education to  Save  Student-athletes

Introduction:
Sudden cardiac death (SCD) among athletes is a rare but tragic occurrence that has garnered significant attention due to its sudden and unexpected nature. While athletes are often considered individuals in excellent health, the reality is that they can be susceptible to certain cardiac conditions that predispose them to SCD.  

Understanding Sudden Cardiac Death:
SCD is defined as an unexpected death due to cardiac causes that occur within one hour of symptom onset. In athletes, SCD is often attributed to structural or electrical abnormalities of the heart, including hypertrophic cardiomyopathy (HCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), coronary artery anomalies, and inherited channelopathies such as long QT syndrome (LQTS) and Brugada syndrome. These conditions can go undetected and may manifest during periods of intense physical exertion, making athletes particularly vulnerable.

Risk Factors and Screening:
Young athletes, in particular, face unique risk factors for SCD, including genetic predispositions, training intensity, and environmental factors. The sudden and devastating nature of SCD in this demographic underscores the importance of pre-participation screening programs. While controversial, electrocardiogram (ECG) screening has been proposed as a tool to detect underlying cardiac abnormalities in athletes. However, challenges such as cost-effectiveness, false positives, and variability in interpretation remain significant hurdles to widespread implementation.

Prevention and Psychosocial Implications:
Preventing SCD in young athletes requires a multi-faceted approach that encompasses education, early detection, and appropriate management of cardiac conditions. Increasing awareness among athletes, coaches, and medical professionals about the signs and symptoms of cardiac abnormalities is crucial for prompt intervention. Additionally, implementing standardized screening protocols, including ECG and echocardiographic testing where feasible, can aid in identifying at-risk individuals and mitigating the risk of SCD through lifestyle modifications, medication, or, in some cases, surgical intervention.
The sudden loss of a young athlete to SCD not only impacts the individual’s family and friends but also reverberates throughout the sporting community. The psychological toll of such events can be profound, leading to feelings of grief, guilt, and fear among fellow athletes and coaches.

Treatment and Effectiveness of Hands-Only CPR and AED Use:
Out-of-hospital sudden cardiac death (SCD) is a leading cause of mortality worldwide, with survival rates often dependent on the timely administration of cardiopulmonary resuscitation (CPR) and defibrillation. Hands-only CPR, coupled with the use of automated external defibrillators (AEDs), has emerged as a simple yet effective strategy for bystanders to intervene in SCD emergencies. This paper examines the importance and effectiveness of hands-only CPR and AED in out-of-hospital SCD scenarios.

Hands-only CPR, also known as compression-only CPR, involves uninterrupted chest compressions without mouth-to-mouth rescue breathing. This simplified technique is easy to learn and remember, making it accessible to a broader segment of the population. The American Heart Association (AHA) recommends hands-only CPR for untrained bystanders who witness a sudden collapse in an adult victim. By focusing solely on chest compressions, bystanders can maintain blood circulation and oxygen delivery to vital organs, significantly improving the chances of survival until professional help arrives.

Numerous studies have demonstrated the efficacy of hands-only CPR in improving survival outcomes for out-of-hospital cardiac arrest (OHCA) patients. The simplicity of the technique increases the likelihood of bystander intervention, leading to earlier initiation of CPR and ultimately better outcomes. Moreover, hands-only CPR minimizes the hesitation or reluctance to perform CPR, particularly among laypersons who may be unfamiliar with traditional CPR techniques involving rescue breathing. As a result, hands-only CPR has been credited with saving countless lives and increasing survival rates in SCD incidents.

More specifically, research by the American Heart Association (AHA) and the European Resuscitation Council (ERC) consistently supports the efficacy of hands-only CPR in maintaining blood circulation and oxygen delivery to vital organs. A study by Rea et al. (2010) found that bystander-initiated hands-only CPR was associated with significantly higher rates of survival to hospital discharge compared to conventional CPR. Similarly, a meta-analysis by Sasson et al. (2010) reported improved outcomes with hands-only CPR, highlighting its simplicity and accessibility for laypersons.

AEDs are portable devices designed to deliver an electric shock to the heart to restore normal rhythm in cases of sudden cardiac arrest. These user-friendly devices analyze the heart’s rhythm and prompt the operator to administer a shock if indicated. When combined with hands-only CPR, AEDs significantly enhance the chances of survival for OHCA victims.  

Integration of Hands-Only CPR and AED:
The integration of hands-only CPR and AED represents a powerful response strategy for out-of-hospital SCD emergencies. Bystanders witnessing a sudden collapse should immediately call emergency services, initiate hands-only CPR, and locate the nearest AED. AEDs should be retrieved and applied as soon as possible, ideally within the first few minutes of cardiac arrest.  The integration of AEDs into the chain of survival further enhances the effectiveness of resuscitative efforts. A study by Hallstrom et al. (2004) demonstrated a threefold increase in survival rates when AEDs were deployed promptly by bystanders in out-of-hospital SCA cases. Similarly, a systematic review by Ong et al. (2007) concluded that AED use by laypersons significantly improved survival outcomes, particularly when combined with CPR.

Health Care Disparities for CPR Training, Readiness and AED use:

Healthcare disparities in access to CPR and AEDs persist globally, exacerbating health outcomes for marginalized communities. Access to CPR training and AED placement varies significantly based on socioeconomic status, geographic location, and race.

The CARES (Cardiac Arrest Registry to Enhance Survival) registry collects data on out-of-hospital cardiac arrests and tracks survival rates. It is and will continue to be an invaluable tool for understanding how different demographics, including minorities, are affected by cardiac events and how CPR and AED interventions impact outcomes. Analyzing this data helps identify disparities in access to emergency care and informs strategies to improve survival rates among minorities.   More specifically, research indicates that individuals from lower-income backgrounds are less likely to receive CPR training, leading to delayed or inadequate response during cardiac emergencies. Similarly, AED distribution tends to be concentrated in wealthier neighborhoods and public spaces, leaving underserved communities at a disadvantage during critical situations.

Language and cultural barriers further compound healthcare disparities in CPR and AED utilization. In multicultural societies, disparities in language proficiency can hinder effective communication during emergencies, impeding timely access to life-saving interventions. Moreover, cultural beliefs and norms may influence perceptions of CPR and AED usage, leading to reluctance or fear of involvement in emergency response efforts. Addressing these disparities requires targeted educational campaigns and community outreach initiatives that prioritize cultural sensitivity and language accessibility.

Summary:
Sudden cardiac death in athletes, particularly young individuals, is a complex and multifaceted issue that demands attention from both the medical and sporting communities. While rare, the devastating consequences of SCD underscore the importance of proactive measures aimed at prevention, early detection, and appropriate management of cardiac conditions in athletes. By prioritizing education, screening, and psychosocial support, we can work towards reducing the incidence of SCD and ensuring the safety and well-being of athletes at all levels of competition.

Hands-only CPR and AED play indispensable roles in the chain of survival for out-of-hospital sudden cardiac arrest. These interventions empower bystanders to take immediate action and provide vital support to OHCA victims until professional help arrives. By promoting widespread education, training, and accessibility of AEDs, communities can enhance their capacity to respond effectively to SCD emergencies, ultimately saving lives and minimizing neurological damage. 

Efforts to mitigate healthcare disparities in CPR and AED access must also address systemic inequalities in healthcare infrastructure and resource allocation. Improving access to CPR training and AEDs requires policy interventions that prioritize equitable distribution and funding mechanisms. Community-based initiatives, coupled with partnerships between healthcare providers, community organizations, and policymakers, are essential for promoting inclusivity and ensuring that all individuals have the knowledge and resources to respond effectively to cardiac emergencies, regardless of their background or socioeconomic status.

I+COMPRESS is such initiative.


References:
1. Rea, T.D. et al. (2010). “Outcomes among Bystanders of Out-of-Hospital Cardiac Arrest in the Public-Access Defibrillation Era.” Circulation, 122(4), 430-437.
2. Sasson, C. et al. (2010). “Part 8: Adult Advanced Cardiovascular Life Support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.” Circulation, 122(18 Suppl 3), S729-S767.
3. Hallstrom, A.P. et al. (2004). “Public-Access Defibrillation and Survival after Out-of-Hospital Cardiac Arrest.” New England Journal of Medicine, 351(7), 637-646.
4. Ong, M.E. et al. (2007). “Effectiveness of Bystander Cardiopulmonary Resuscitation and Survival Outcomes in Out-of-Hospital Cardiac Arrest.” Annals of Emergency Medicine, 50(5), 505-517.

Midwestern University Student Program

CorVita Science Foundation (CSF) in partnership with Midwestern University’s Institute for Healthcare Innovation (IHI), has established a cutting-edge training program for medical students seeking further education in clinical research. These students have access to data from current and past enrolled clinical trials providing a real-life apprenticeship in clinical scholarly activity. 

Each summer the students sit classroom style and learn about the different methods of clinical trial research. The course details are below:

Program Courses (each lecture is one hour, each week):

  • Fundamentals of Clinical Trials in Cardiovascular Medicine
  • Review of Federal and Regulatory Guidelines
  • The Drug Development Process
  • Informed Consent Process
  • The Standard IRB Process
  • Creating Research Protocols
  • Evaluation of Contract Agreements and Budgets
  • Clinical Trial Initiation 
  • CMS Registration and Approval Process
  • Monitoring and Auditing of Trials

In addition, students also get the option to work on several projects with physician leaders. These cardiovascular specific projects allow the physician to mentor the students early in their careers. Here is a list of projects:

I. Official Intelligence and Machine Learning 

This project, which was started with the 2017 summer student group, evaluates subcutaneous ICD (S-ICD) stored electrocardiographic data. The research will include data-basing 10,000 S-ICD events digital electrograms and adjudicating the events carefully and methodically. The project will teach students how to set up adjudication methods, intellectual property, data repositories for digital data, contracting for data release and adjudication of electrogram events.

II. Center for Predictive Analytics and Data Mining

This 2018 summer research project will continue as the students had successfully cataloged 250 patients with atrial fibrillation last year. The pilot project was to test a predictive analytic regarding medication adherence and compliance. This next stage of this project is to validate the predicative analytic score and to expand to new healthcare analytics. The Center will teach students the importance of objective measures of risk/benefit in caring for patients in clinical settings, advance their knowledge on the utility of statistical analysis of subjective behavior, objective data points, clinical trail data points, clinical trial data utility (such as metanalysis) and non-medical metrics to guide clinical care. 

III. Longitudinal Clinical Registry Suite

This registry will recreate a new clinical longitudinal registry for patients at high risk of sudden death and ventricular arrhythmia’s. This project will involve developing, from scratch, a data logging platform on RedCap. The students will gain a better understanding of the value of physician led databases, informed consent and protocol development, data entry and clinical communication/writing. 

IV. Video Education Laboratory

A new project to create video education content to expand the reach of expert knowledge across the globe. This project will be done in phases with a prospective research platform that tests two methods of video education using two topics. The students will develop a project plan, research tools for eventual analysis to set the stage for content development and launching the video content to end users internationally.

Video 1: The first topic will include a full deep dive into explaining the sensing algorithm for the subcutaneous ICD (currently described worldwide as a black box).

Video 2: Begin to create a research curriculum video for students worldwide to detail the Art in the Science of Medicine.

Childers Electrocardiology Research Center

The CorVita Science Foundation is proud to establish a research center and fellowship in memory of an international authority’s passion for electrocardiology.

The Rory Childers Electrocardiology Research Center and Fellowship carries on the legacy of its namesake, the charismatic Irish physician and teacher who mentored medical students and Cardiology Fellows for more than half-century at the University of Chicago.


The Childers Electrocardiology Research Center (CERC) looks to fund:

  • A fellowship for a visiting Irish Cardiology Registrar to research the electrocardiogram
  • Establishing an international elctrogram core laboratory
  • Production of a novel series for educational ECG video modules
  • Advances in the field of human elctrocardiology through clinical research

Dr. Childers (1931-2014) was an expert on the use and interpretation of electrocardiograms (ECGs), raising the benchmark for excellence in clinical electrophysiology and establishing ECGs as a critical diagnostic tool. He also pioneered the use of ECGs in ambulances to expedite treatment of heart-attack patients, an innovation that has saved lives worldwide. A Professor of Medicine and Executive Director of the Heart Station at the University of Chicago, Dr. Childers taught generations of medical students, residents and fellows – and through his scholarly writings, physicians worldwide – how to interpret the most nuanced readings on ECGs.

“Electrocardiograms are routinely performed hundreds of times a day in every hospital around the world, but reading one is far from routine,” said Martin Burke, DO, Founder and Chief Scientific Officer of the CorVita Science Foundation. “The details matter. One little squiggle can alter a diagnosis. Rory was the expert on those details, especially the subtle ones that warn of an impending catastrophe,” Dr. Burke said.

So extraordinary were Dr. Childer’s interpretive skills that his finely honed techniques were analyzed in a 2015 article in the Journal of Electrocardiology (48 [2015] 43-44) by Bond et al., “Novel Approach to Documenting Expert ECG Interpretation Using Eye Tracking Technology: A Historical and Biographic Representation of the Late Dr. Rory Childers in Action.”  A video on which the article is based shows how the researchers used heat map technology and audio data to visualize Dr. Childer’s eye gaze and voice while he read 12 different ECGs.

Blessed with a keen intellect, the bearded, Dublin-trained specialist was a gregarious storyteller passionate about history; Irish, French and Russian literature; music; and the arts. His empathy, patience and droll sense of humor were legendary.

“In teaching cardiology and physical diagnosis, Rory had a magical combination of a thespian’s humor and scholarly precision that captivate multiple generations of students,” Dr. Burke said.

Dr. Childers won a master teacher award from the cardiology section so often that it was renamed The Rory Childers Cardiovascular Teaching Award in 2005 to give other faculty members a chance. The famously hands-on diagnostician read an estimated 50,000 ECGs a year. A tireless investigator, he conducted seminal research on super-normal conduction and published over 100 scholarly articles, primarily on electrocardiology.

Dr. Childers was a core member of an international team of experts that standardized and updated the interpretation of ECGs, bringing consistency to an array of imprecise and overlapping terms. He also was instrumental in computerizing the diagnosis of disorders detected by ECG.

Dr. Childers, who was born in Paris, grew up in a distinguished Irish family. His father was the country’s fourth president, and his grandfather a famous author and Irish nationalist. He received a BA with honors in French and English literature and an MD from Trinity College, Dublin. He completed internships in medicine and surgery in England and a residency at Royal City of Dublin Hospital, followed by a one-year fellowship in cardiology at the Massachusetts General Hospital. Dr. Childers then returned to Ireland, where he led two of the first cardiac catheterization laboratories in Dublin and was a lecturer in cardiac physiology at Trinity College. He also was the principal investigator for the Irish research arm of the Ireland-Boston Diet-Heart Study, the initial phase of which he designed, for the Harvard School of Public Health. He was subsequently awarded a fellowship at the University of Chicago and joined the faculty in 1964, rapidly advancing to become a Professor of Medicine, where his personality, intellect and teaching grew in renown.

Dr. Childers, who once counted among his patients and friends the Irish writer Brendan Behan, died of cardiac arrest at age 83 on August 27, 2014. He was laid to rest in an ancient churchyard in Wicklow, Ireland, with an American flag and the Irish tricolors fluttering by his headstone.

In order to commemorate Rory’s lifetime of work, the Foundation, through donations, will sponsor a fellow from his home country of Ireland, partnering with the Irish Heart Society to continue his focus and passion.

The CSF will establish an ECG core laboratory in Dr. Childer’s name, headquartered in Chicago, to continue his clinical research in the field of human electrocardiology.

Center for Predictive Analytics and Data Mining

This 2018 summer research project continued after Midwestern University medical students successfully cataloged 250 patients with atrial fibrillation in 2017. The pilot project tested a predictive analytic regarding medication adherence and compliance. The goal of next stage of this project is to validate the predictive analytic score and to expand to new healthcare analytics. The center will teach students the importance of objective measures of risk/benefit in caring for patients in clinical settings, advance their knowledge on the utility of statistical analysis of subjective behavior, objective data points, clinical trial data points, clinical trial data utility (such as metanalysis) and non-medical metrics to guide clinical care. To learn more about predictive analytics click here or here. 

Official Intelligence and Machine Learning Center 

The CorVita Science Foundation is excited to introduce its Official Intelligence and Machine Learning Center (OI-MLC). Machine Learning (ML), also referred to as Artificial Intelligence (AI), is not a new concept to medicine but an evolving one. 

For those who aren’t familiar to its application to medicine, AI or ML is able to scan through medical records and assist physicians in making more informed treatment options for their patients. Based on a patient’s medical history and how it compares to similarly diagnosed patients and treatment data, physicians will be able to better predict what tests to request, make more accurate diagnoses and formulate a more customized and effective care plan. There are several companies, including the more familiar IBM’s Watson, that are working on creating more predictive tools to also help improve patient outcomes and avoid unnecessary hospitalizations. 

CorVita Science Foundation in partnership with Boston Scientific is researching how the subcutaneous implantable cardioverter defibrillator (S-ICD) and the leadless cardiac pacemaker (LCP) can work together to prevent cardiac sudden death and reduce the re-operations rates over time. The research combines the LCP with the S-ICD through wireless conductive communication allowing the delivery of appropriately timed sensing and pacing by using the individuals strengths of both devices. This research has been preformed in animal studies with high success. To learn more click here. 

The Official Intelligence and Machine Learning Project stems from the research done in 2017 evaluating the S-ICD stored electrocardiographic data. The extension of this research will include data-basing 10,000 S-ICD events digital electrograms and adjudicating the events carefully and methodically. The project will include instruction on setting up adjudication methods, intellectual property, data repositories for digital data, contracting for data release, adjudication of electrogram evens. 

To read more about our Official Intelligence and Machine Learning Center, click here