Damar Hamlin and the Commonality of Cardiac Arrest Emergencies

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A Mayo Clinic cardiologist discusses the national variability in CPR and AED access, and the actions that saved Hamlin's life during Monday Night Football.

Early into this week’s Monday Night Football matchup between the Buffalo Bills and Cincinnati Bengals, second-year Bills player Damar Hamlin, 24 years old, collapsed on the field after completing a tackle.

As emergency care response unfolded on the field between a slew of ESPN commercial breaks and sporadic reports on Hamlin’s status, millions of viewers came to realize they were not witnessing a common football injury.

Through the night, it was come to understood that Hamlin had suffered from a cardiac arrest, and required cardiopulmonary resuscitation (CPR) as well as an automated external defribillator (AED) shock before being transported to the University of Cincinnati Medical Center, where as of Wednesday morning he remains in stable but critical condition.

While many of his peers took to social media and news outlets to speculate on the actual diagnosis that may have triggered Hamlin’s cardiac arrest, cardiologist Michael J. Ackerman, MD, PhD, spoke with HCPLive on the significance of timely, thorough and proven medical response in such an emergent event, regardless of the cause.

“His collapse…is a reminder of what is our readiness in the public square, if someone goes down and goes into sudden cardiac arrest,” Ackerman said. “That readiness, I would guess, is very heterogenous across the country.”

Ackerman serves as director of the Mayo Clinic Windland Smith Rice Genetic Heart Rhythm Clinic and the Windland Smith Rice Sudden Death Genomics Laboratory, as well as president of the Sudden Arrhythmia Death Syndromes Foundation. He discussed the variability of CPR training prioritization across the US, noting some states require completion prior to a student graduating high school. Very similarly, AED resourcing and utility can fluctuate by state, region, and even industry: airports, casinos and indeed, stadiums are generally better equipped than other public places.

“But that doesn’t mean if you or I were to go down and have it witnessed, could an AED get to you or me within 3-5 minutes,” Ackerman said. “And I think that’s the goal, that any and every community can use this tragic moment to say, ‘What is the state of readiness in that community? How hard would it be to die suddenly in a witnessed collapse in Rochester, Minnesota versus Rochester, New York, and so on.’”

As Ackerman explained, the progression of care from chest compressions to AED shock is fairly simple and linear, regardless of the patient’s cause of condition—“it just has to be rehearsed, readied, and in a plan.”

What he saw from the Bills’ and Bengals’ medical staff on Monday night was emblematic of that strategy. “They were heroes (Monday) night, in terms of getting meaningful, effective chest compressions going right away, getting the ambulance right away,” Ackerman said.

He also discussed the “premature rush to judgement” among his peers who were quick to commit to speculative diagnoses while watching replays of Hamlin’s incident. He stressed the need to avoid diagnostic “tunnel vision” in instances of cardiac arrest. The reality is Hamlin’s circumstance is not as rare as many would believe.

“I think it’s fair to say that 10-20 of (Monday) night’s episodes happen every single day in the United States to young people—people his age and younger,” Ackerman said. “The episode itself wasn’t rare; the moment was rare and unique.”

Rather, the actions taken by responders resembled “a final common pathway where a lot of different cardiac vulnerabilities could lead to the situation where the heart suddenly, chaotically went electrically out of control into a potentially lethal ventricular arrhythmia.”

Ackerman stressed that responders should not hesitate to call for ambulatory response, initiate chest compressions or CPR, and seek out AED feedback and shock if necessary.

“Time is life,” he said. “If it’s the heart that’s in chaos, you need to get electricity to that heart and get ordered restored as fast as you can. Every minute is a minute where the outcome gets worse.”