Assessing Effective Practices and Barriers to Creating School and Community Partnerships for a Sudden Cardiac Death Prevention Program: A National Project ADAM® study.

OBJECTIVES: Project ADAM (Automated Defibrillators in Adam's Memory) is a national collaborative to improve outcomes for out-of-hospital sudden cardiac arrest. Given Project ADAM's expansion, we sought to identify effective methods to partner with community leaders and understand barriers to engagement. Our aim was to establish effective practices to guide affiliates and optimize site operations and partnerships. METHODS: We conducted a survey of all Project ADAM sites in 2020. Medical Directors and Program Coordinators were included for generalizability. The survey consisted of 20 questions covering the domains of communication, goals for partner organizations, partnership barriers, staff time commitments, and Project ADAM program needs. RESULTS: Thirty-one members responded: 14 Medical Directors and 17 Program Coordinators. E-mail was the predominant method to initiate (58%) and maintain (87%) contact with partner organizations, though telephone (21%) and in-person visits (14%) were common for initiating contact. Presentations at school board, Emergency Medical Services, and athletic director meetings and student/family testimonials were powerful engagement tools. Barriers to partnership varied, revolving around limited school budgets, overburdened staff, and Covid-19. Limited time, difficulty coordinating schedules, and lack of dedicated resources were common challenges for Project ADAM sites. Only 36% of Medical Directors receive institutional recognition of Project ADAM effort. CONCLUSIONS: Project ADAM's partnership with community stakeholders creates unique opportunities and challenges. Optimal communication methods should be identified early for each school, with regular interaction for long-term success. Institutional recognition of Project ADAM efforts may boost success. Additionally, the Covid-19 pandemic created numerous challenges and may spur operational changes.

Sudden cardiac arrest during the COVID-19 pandemic: A two-year prospective evaluation in a North American community.

BACKGROUND: Early during the coronavirus disease 2019 (COVID-19) pandemic, higher sudden cardiac arrest (SCA) incidence and lower survival rates were reported. However, ongoing effects on SCA during the evolving pandemic have not been evaluated. OBJECTIVE: The purpose of this study was to assess the impact of COVID-19 on SCA during 2 years of the pandemic. METHODS: In a prospective study of Ventura County, California (2020 population 843,843; 44.1% Hispanic), we compared SCA incidence and outcomes during the first 2 years of the COVID-19 pandemic to the prior 4 years. RESULTS: Of 2222 out-of-hospital SCA cases identified, 907 occurred during the pandemic (March 2020 to February 2022) and 1315 occurred prepandemic (March 2016 to February 2020). Overall age-standardized annual SCA incidence increased from 39 per 100,000 (95% confidence [CI] 37-41) prepandemic to 54 per 100,000 (95% CI 50-57; P <.001) during the pandemic. Among Hispanics, incidence increased by 77%, from 38 per 100,000 (95% CI 34-43) to 68 per 100,000 (95% CI 60-76; P <.001). Among non-Hispanics, incidence increased by 26%, from 39 per 100,000 (95% CI 37-42; P <.001) to 50 per 100,000 (95% CI 46-54). SCA incidence rates closely tracked COVID-19 infection rates. During the pandemic, SCA survival was significantly reduced (15% to 10%; P <.001), and Hispanics were less likely than non-Hispanics to receive bystander cardiopulmonary resuscitation (45% vs 55%; P = .005) and to present with shockable rhythm (15% vs 24%; P = .003). CONCLUSION: Overall SCA rates remained consistently higher and survival outcomes consistently lower, with exaggerated effects during COVID infection peaks. This longer evaluation uncovered higher increases in SCA incidence among Hispanics, with worse resuscitation profiles. Potential ethnicity-specific barriers to acute SCA care warrant urgent evaluation and intervention.

Sudden Cardiac Arrest in a Patient With COVID-19 as a Result of Severe Hyperkalemia After Administration of Succinylcholine Chloride for Reintubation. A Case Report.

Background: We present a case study of a man with coronavirus disease 2019 (COVID-19) who developed cardiac arrest as a result of hyperkalemia following administration of chlororsuccinylcholine during endotracheal intubation. Case Summary: A patient with a severe course of COVID-19, hospitalized in the Intensive Care Unit, underwent reintubation on day 16. The applied scheme was rapid sequence induction and intubation with administration of chlororsuccinylcholine. Immediately after intubation, there was a sudden cardiac arrest due to hyperkalemia (cK + 10.2 meq/L). Treatment was initiated as per guidelines, which resulted in a return to spontaneous circulation after 6 min. Conclusion: Chlorsucynylcholine may cause life-threatening hyperkalemia. We recommend using rocuronium as a neuromuscular blocking agent in critically ill COVID-19 patients due to its more optimal safety profile.

Electrocardiographic findings in young competitive athletes during acute SARS-CoV-2 infection.

Initial guidelines recommended a 12-lead electrocardiogram (ECG) in young competitive athletes following SARS-CoV-2 infection to screen for myocarditis. However, no data are available that detail ECG findings before and after SARS-CoV-2 infection in young athletes without clinical or imaging evidence of overt myocarditis. This study applied the International Criteria for ECG interpretation in a cohort of 378 collegiate athletes to compare ECG findings at baseline and during the acute phase of SARS-CoV-2 infection. Our results suggest that ECG changes can occur in the absence of definitive SARS-CoV-2 cardiac involvement in young competitive athletes.

Transient Hypogonadism Is Associated With Heart Rate-Corrected QT Prolongation and Torsades de Pointes Risk During Active Systemic Inflammation in Men.

Background Systemic inflammation and male hypogonadism are 2 increasingly recognized "nonconventional" risk factors for long-QT syndrome and torsades de pointes (TdP). Specifically, inflammatory cytokines prolong, while testosterone shortens the heart rate-corrected QT interval (QTc) via direct electrophysiological effects on cardiomyocytes. Moreover, several studies demonstrated important interplays between inflammation and reduced gonad function in men. We hypothesized that, during inflammatory activation in men, testosterone levels decrease and that this enhances TdP risk by contributing to the overall prolonging effect of inflammation on QTc. Methods and Results We investigated (1) the levels of sex hormones and their relationship with inflammatory markers and QTc in male patients with different types of inflammatory diseases, during active phase and recovery; and (2) the association between inflammatory markers and sex hormones in a cohort of male patients who developed extreme QTc prolongation and TdP, consecutively collected over 10 years. In men with active inflammatory diseases, testosterone levels were significantly reduced, but promptly normalized in association with the decrease in C-reactive protein and interleukin-6 levels. Reduction of testosterone levels, which also inversely correlated with 17-ß estradiol over time, significantly contributed to inflammation-induced QTc prolongation. In men with TdP, both active systemic inflammation and hypogonadism were frequently present, with significant correlations between C-reactive protein, testosterone, and 17-ß estradiol levels; in these patients, increased C-reactive protein and reduced testosterone were associated with a worse short-term outcome of the arrhythmia. Conclusions During systemic inflammatory activation, interleukin-6 elevation is associated with reduced testosterone levels in males, possibly deriving from an enhanced androgen-to-estrogen conversion. While transient, inflammatory hypotestosteronemia is significantly associated with an increased long-QT syndrome/TdP risk in men.

Promoting an Emergency Action Plan for Sudden Cardiac Arrest in Youth Sports During a Pandemic.

INTRODUCTION: Pandemic-related restrictions increased the risk of delayed emergency response of bystanders to sudden cardiac arrest among youth athletes. Education and SCA emergency preparedness, implemented by nurse leaders and adapted to environmental changes, can greatly reduce the risks associated with an SCA episode. METHOD: A nurse-led, quality improvement pilot project was implemented in a recreational youth soccer league. The project included the implementation of an emergency action plan (EAP; with or without the pandemic and social-distancing restrictions) for bystanders responding to SCA. RESULTS: Participants showed significant improvement in knowledge and perceptions of SCA and emergency response (p < .001). Willingness to initiate cardiopulmonary resuscitation (CPR) improved (p = .127), and fear to engage in EAP decreased (p = .119) following an educational intervention on SCA. DISCUSSION: Nurse-led SCA education and implementation of youth league EAP successfully demonstrated safety in SCA preparedness and best practice recommendations for youth sports from the Interassociation Task Force.

A Case of Ventricular Fibrillation in Asymptomatic COVID-19.

In this report, we present a case of ventricular fibrillation (VF) arrest in an asymptomatic coronavirus disease 2019 (COVID-19) patient with no cardiac history and normal cardiac workup. Cardiac involvement in COVID-19 has been described previously in hospitalized patients with severe COVID-19. To our knowledge, this is the first report to describe VF arrest in a patient who was incidentally found to have COVID-19.

The Role of the Automated Implantable Cardioverter Defibrillator (AICD) for Secondary Prevention in the COVID-19 Era.

Life-threatening arrhythmias have been variably reported among patients hospitalized for COVID-19 infection. Sudden cardiac arrest (SCA) in COVID-19 patients is an alarming concern for clinicians. Multiple factors play an important role in the development of SCA in patients with severe systemic illness. We describe a case of COVID-19 in a New York City hospital in Spring 2020 that rapidly developed SCA and, before discharge, received a single lead transvenous implantable cardioverter defibrillator for secondary prevention. This case highlights the use of an automated implantable cardioverter-defibrillator as a secondary preventive measure irrespective of left ventricular function as a means of preventing recurrence of SCA as a sequela of COVID-19.

Non-ST Segment Elevation Myocardial Infarction in a Patient with COVID-19.

Coronavirus disease 2019 (COVID-19) is associated with a wide spectrum of cardiovascular (CV) manifestations. Primary cardiac manifestations of COVID-19 disease include acute coronary syndrome (ACS), myocarditis, and arrhythmias. Secondary cardiac involvement is usually due to a systemic inflammatory syndrome and can manifest as acute myocardial injury/biomarker elevation and/or heart failure (congestive heart failure). Elevated cardiac biomarkers indicate an unfavorable prognosis. Health-care systems of the world are rapidly learning more about the manifestations of COVID-19 on the CV system, as well as the strategies for the management of infected patients with CV disease. There is still a paucity of literature on the management of non-ST-segment elevation ACSs in the current literature. Herein, we report the case of a 53-year-old male patient, who presented with severe COVID-19 pneumonia deteriorating into adult respiratory distress syndrome requiring mechanical ventilation. The patient had a history of coronary artery disease. During the course of treatment, he developed sudden cardiac arrest with diffuse ST-segment depression, which was treated by percutaneous coronary intervention to the left anterior descending artery. The patient had a favorable outcome with excellent recovery from the disease.

[Out-of-hospital sudden cardiac arrest and COVID-19 pandemic]. / Arrêt cardiaque extrahospitalier et pandémie de la COVID-19.

Since the appearance of the COVID-19 pandemic in 2020, the direct mortality related to COVID-19 infections has been monitored worldwide, with a daily count of the number of deaths due to COVID-19. Several measures have been undertaken in the societal and professional field, and the healthcare systems have been reorganized to limit the virus spread, and to cope with the surge of hospital admissions for COVID-19. Questions have been raised regarding the indirect effect of the pandemic, with uncertainties regarding the impact of delays in non-COVID diseases management, due to lockdown, postponement of non-urgent medical consultations and interventions, and decrease in screening. Sudden cardiac death could have been impacted by all those changes, and is generally a good surrogate of public health. In the current article, we review the impact of the COVID-19 pandemic on the epidemiology and outcome of sudden cardiac death.