Heart Attacks at School Involve More Adults Than Kids

MONDAY Aug. 27, 2007 -- When a student dies from cardiac arrest while on school grounds, it makes the evening news, but the actual incidence of heart attacks on school property is rare, and most of the victims are adults, researchers report.

After reviewing 16 years of emergency medical service calls in the Seattle area, researchers found that faculty and staff were 25 times more likely than students to suffer cardiac arrest. The report is in the Sept. 18 issue of Circulation.

"Cardiac arrest does occur in schools, though it is quite uncommon," said lead researcher Dr. Tom Rea, an associate professor of medicine at Harborview Medical Center and the University of Washington School of Medicine. "It is much more likely to occur in adults as opposed to students."

The goal of the study is to provide data to people who are considering how they want to set up emergency response systems in schools, Rea said.

"This study gives the backbone for policymakers and schools to make the decision of how much priority are they going to give to cardiac arrest, especially implementing automated external defibrillator (AED) programs," Rea said.

In the study, Rea's team looked at 3,773 cardiac arrests in King County, Washington, that occurred between January 1990 and December 2005. Of these cases, 97 occurred in the 641 schools that ranged from preschools to colleges. In seven of those cardiac arrests, the affiliation between the victim and the school was unknown.

The researchers found that of the remaining 90 cases, 12 students suffered cardiac arrest -- eight were 18 or younger. There were 33 cardiac arrests among faculty and staff. In addition, 45 adults who had no connection to the school had cardiac arrest while on school property that included sports fields and tracks.

Of the eight younger students who suffered cardiac arrest, four had known heart or lung disease or were severely developmentally disabled, Rea's group reported.

The remaining question is what, if anything, should be done by schools to prepare for these rare events. The idea that has gotten the most attention is training school personnel in cardiopulmonary resuscitation (CPR) and early defibrillation using AEDs. AEDs are used to restart the heart after cardiac arrest.

Rea was noncommittal about what should be done. "It is a loaded question," he said. "When a tragic event occurs in a school, it has far-reaching effects. Although these events are extremely uncommon, you have to decide if you want to be prepared for even the most uncommon event. It's a decision that individual schools or school districts have to grapple with."

One expert thinks these findings show the need for expanding CPR training and the availability of AEDs in schools.

"It is estimated that over 350,000 individuals die of sudden cardiac arrest in the U.S. each year," said Dr. Gregg C. Fonarow, a professor of cardiology at the University of California, Los Angeles. "Improved cardiac arrest recognition and emergency activation, early CPR, and early defibrillation, including the use of AEDs, can significantly increase the chances of surviving sudden cardiac arrest."

This study provides important community-based data on the incidence, circumstances and outcome of cardiac arrest in the school setting, Fonarow said. "This study found that half of the student cardiac arrests were not associated with physical exertion or sports participation, and student risk was similar for elementary school, middle school, high school and college," he said.

The majority of cardiac arrests in schools occurred among adults, Fonarow noted. "The finding supports the assertion that school-based CPR and AED programs would benefit not only students, but faculty, staff members, as well as school visitors, and provides important data for considering increasing CPR training and the availability of AEDs in the school setting," he said.

Another expert disagrees. The very rarity of cardiac arrests at schools makes having AEDs available unnecessary, he said.

"Any cardiac arrest in a student, especially if it occurs on school grounds, gets a lot of media attention," said Dr. Byron Lee, an associate professor of cardiology at the University of California, San Francisco. "This has led some to call for AED in every school."

However, because cardiac arrest at schools is extremely rare, and only a minority of cardiac arrests occurs in the students, "it seems unlikely that putting an AED in every school would be cost-effective," Lee said.

Posted: August 2007


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