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Consensus statement released on CV care of college student-athletes
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A consensus statement crafted by multiple associations recommends best practices for CV care of college student-athletes, including on how to evaluate students before athletic participation and how to plan for a sudden cardiac arrest event.
The statement was developed by a task force made up of representatives from numerous associations, including the American College of Cardiology’s Sports and Exercise Cardiology Section Leadership Council and the American Heart Association, convened by the National Collegiate Athletic Association (NCAA) in 2014.
“This interassociation statement, developed and endorsed by leading national medical and sports medicine organizations, is the result of an exceptional collaborative effort and will serve as a meaningful resource for our member schools in support of the cardiac health of college athletes,” Brian Hainline, MD, NCAA chief medical officer and lead author of the statement, said in a press release.
Pre-participation evaluation
The statement covers two main topics: pre-participation evaluation of student-athletes and emergency action plans for cardiac arrest.
According to the statement, the pre-participation evaluation should include a family history and physical examination such as the AHA’s 14-point evaluation.
The evaluation should be conducted on campus under the direction of the institution’s director of medical services, or be reviewed by someone supervised by the director of medical services.
There has been much debate about whether student-athletes should undergo ECG screening before participation. The statement does not recommend for or against the practice, but delineates best practices should an institution choose to implement ECG screening. These include that the program should be planned by a multidisciplinary team, students should be informed of the purpose of the screening as well as its benefits and risks, modern ECG interpretation standards are used and oversight by a skilled cardiologist is available.
Cardiac arrest action plan
Hainline and colleagues wrote that institutions should have a written emergency action plan for treating cardiac arrest that has been reviewed and rehearsed by all athletic trainers and team physicians, the athletic director and director of medical services, and all strength and conditioning coaches.
According to the statement, the emergency action plan for cardiac arrest should have the following:- certification of all athletic trainers, team physicians and strength and conditioning coaches in use of CPR and automated external defibrillators;
- establishment of a communication system ensuring rapid and coordinated response, both internally and for EMS;
- Placement of AEDs near all high-risk venues, including weight rooms, arenas, stadiums, practice facilities and any fields hosting organized sports;
- placement of clearly visible signs indicating where AEDs are located;
- not placing AEDs behind locked doors and implementing a system to check and sign off that each AED is properly charged and has functioning electrode pads; and
- advance determination and securing of EMS entry and exit at high-volume events.
The authors also made recommendations for future research, calling for more study of incidence of life-threatening CV events in college athletes, CV screening strategies and etiology of sudden cardiac death in young people. – by Erik Swain
Disclosure: Hainline reports no relevant financial disclosures. Please see the full statement for a list of the other authors’ relevant financial disclosures.
Perspective
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Rachel Lampert, MD
There are a number of important take-home points in this timely recommendations document. It is appropriate at this point for the NCAA to give best practices for ECG screening without mandating it for member schools. Currently, there are data for and against the lifesaving potential of ECG screening. ECG screening clearly increases sensitivity and specificity for picking up life-threatening conditions. However, just two large studies have actually evaluated outcomes of screening programs — one in Italy, one in Israel — and they came to different conclusions. Both studies have flaws, which have been pointed out in multiple editorials and opinion pieces, including by me. Thus, I see the data on ECG screening as creating equipoise on this question. A good study is urgently needed. Once ECG screening is mandated, it will become impossible to collect these data and get the answer. In my opinion, the bulk of the evidence suggests that screening saves lives and is actually more cost-effective than the currently-recommended history and physical examination. But what is most important right now is to do the right research to answer the question.
The best-practices part of the document stresses standardization of protocols, integration between athletic medicine and cardiology, and training of personnel in acquisition and interpretation of ECGs, all important points. Our university instituted ECG screening last year, and while this document was not yet out, our institution of these practices led to a smooth process in which cardiology and athletic medicine worked together to create a standardized protocol.
There are two novel aspects of document I was particularly excited to see. No. 1, in the management of the athlete with a diagnosed condition, the emphasis on student and family counseling, risk reduction, and making informed decisions amongst all the stakeholders, rather than a dichotomous clear vs. disqualify approach, is great to see. No. 2, the suggestion that training of student-athletes be part of emergency preparedness — in addition to training of personnel working with athletes, care taken to AED placement, and integration with EMS — is an excellent one. As a result, I intend to contact our athletic medicine group to see what they think about getting our student-athletes trained in CPR and AED use.
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