Outcomes of Sudden Cardiac Arrest in U.S. High Schools: A Prospective Study from the National Registry for AED Use in Sports.

Principle Investigator: Jonathan A. Drezner, M.D.

Institution: University of Washington

Title: Outcomes of Sudden Cardiac Arrest in U.S. High Schools: A Prospective Study from the National Registry for AED Use in Sports

Background:
The presence of on-site automated external defibrillators (AEDs) in U.S. high schools is a growing national trend influenced by the success of public access defibrillation programs and the desire to protect young athletes from a catastrophic sudden cardiac death. However, little information is known about the effectiveness of early defibrillation programs to treat sudden cardiac arrest (SCA) in schools. A more precise understanding of the utilization and outcomes of school-based AED programs has tremendous significance for the field of sports medicine and the potential to influence health policy and the scope of medical coverage provided in schools and at athletic events.

The National Registry for AED Use in Sports (AEDSPORTS) was initially developed in 2005 to monitor emergency planning for SCA and AED utilization in the university setting. Since June 2006, the National Operating Committee on Standards for Athletic Equipment (NOCSAE) has supported expansion of this registry to the high school level nationally. Preliminary results from a cross-sectional survey demonstrate a high survival rate for SCA in schools with on-site AED programs. However, the cross-sectional design and study limitations from potential responder bias do not allow a direct comparison of schools with and without AEDs.

This proposal reflects the continued data collection for the National Registry for AED Use in Sports and outlines the first, large prospective study to analyze factors that influence survival from SCA in U.S. high schools. Through a prospective observational design, this study will test the hypothesis that school-based AED programs provide a survival benefit for SCA on school grounds.

Purpose:
The purpose of this study is to prospectively investigate a large cohort of U.S. high schools to determine and quantify the impact of school-based AED programs on survival from SCA.

Primary Outcome Measure:

    1) To determine and compare the survival outcomes (to hospital discharge) for all individuals suffering SCA on school grounds (students, student-athletes, and older non-students such as school staff and spectators) in U.S. high schools with and without school-based AED programs.

Secondary Outcome Measures:

    2) To analyze factors that influence survival from SCA in U.S. high schools including:

      a. Existence of a written emergency action plan (EAP) for SCA.
      b. Consultation with local emergency medical services (EMS) in the development of EAP.
      c. Establishment of local school-based “response team” for cardiac emergencies.
      d. Practice and review of the EAP at least once annually.
      e. Cardiopulmonary resuscitation (CPR) training for coaches and other potential first responders to a SCA on school grounds.
      f. Location and accessibility of on-site school AEDs.
      g. Time from collapse to initiation of CPR.
      h. Time from collapse to deployment of first shock.
    3) To compare outcomes from SCA based on demographic differences in the school setting:

      a. Public vs. private high schools.
      b. Location (rural, suburban, urban, or inner city).
      c. Total student enrollment.
      d. Total number of student-athletes.
    4) To determine the effectiveness of early defibrillation in young athletes with SCA and examine outcomes based on the etiology of SCA.
    5) To establish the annual incidence of SCA in U.S. high schools.

Methods and Study Design: This is a prospective observational study. To date, 3228 U.S. high schools have enrolled in the National Registry for AED Use in Sports and completed a comprehensive survey on emergency preparedness for SCA. This cohort includes U.S. high schools from all 50 states and schools with and without onsite AED programs. The National Registry for AED Use in Sports allows participants to access the registry at anytime and log new incidents of AED use or SCA through completion of a comprehensive survey detailing the resuscitation and outcomes of new SCA events that occur on school grounds. A quarterly email (every three months) will be sent to all schools as a reminder to log new cases of SCA or AED utilization. In addition, each of the 3228 schools will be contacted directly by phone at least once annually for the duration of the study to confirm ongoing participation and ensure all new cases of SCA have been entered into the registry.

This is a longitudinal investigation powered to demonstrate a statistically significant difference in survival ( p < 0.05 ) over a two-year study period comparing U.S. high schools with and without AED programs. This is predicted based on previous studies reporting:

    1) an incidence of SCA in U.S. high schools of 1-2% per year,
    2) an average community survival rate for out-of-hospital SCA of 5-10% applied to high schools without on-site AEDs, and
    3) a survival rate for SCA of 55-60% in high schools with on-site AEDs (based on preliminary data).

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