Sudden Cardiac Arrest in Athletes: What Every Community Should Know

Written By lee kirksey

The recent on-field collapses of elite athletes such as Bronny James and Damar Hamlin captured global attention and reminded the public of a critical reality: sudden cardiac arrest (SCA) is the leading medical cause of sudden death in young athletes in the United States. Although rare, these events are dramatic, highly visible, and often preventable when communities are properly prepared.

Importantly, SCA is not the same as a heart attack. A heart attack occurs when blood flow to the heart muscle is blocked. Sudden cardiac arrest occurs when the heart’s electrical system abruptly fails, causing the heart to stop pumping effectively. Without immediate intervention—typically cardiopulmonary resuscitation (CPR) and defibrillation—death can occur within minutes.

This article reviews the epidemiology, causes, disparities, response science, and the steps institutions and communities should take to improve survival.

Epidemiology and Frequency

Each year in the United States:

  • More than 350,000 out-of-hospital cardiac arrests occur

  • Approximately 90% are fatal, according to the Centers for Disease Control and Prevention (CDC)

  • Among young athletes, the incidence is estimated at 1 in 50,000 to 1 in 80,000 annually

  • By comparison, the incidence in the general population approaches 1 in 1,000 persons annually

Although uncommon, SCA events in athletes receive significant attention because they often involve otherwise healthy young individuals participating in competitive sports.

Source links:

Disparities and Populations at Higher Risk

Research supported by the National Heart, Lung, and Blood Institute (NHLBI) has demonstrated important demographic differences:

  • Black individuals experience approximately twice the rate of sudden cardiac arrest compared with White individuals

  • Young Black male collegiate basketball players have among the highest observed athlete-specific risks, with incidence estimates significantly higher than the overall high-school athlete population

  • Male sex, certain sports (basketball, football), and increasing age within the “young athlete” spectrum are associated with higher rates

These disparities likely reflect a combination of biologic, environmental, and social determinants of health, including differences in access to screening, early detection of heart disease, healthcare utilization, and structural factors affecting cardiovascular risk.

Causes of Sudden Cardiac Arrest in Athletes

The precise mechanisms vary by age group and athletic population. Common causes include:

Structural heart diseases

  • Hypertrophic cardiomyopathy (HCM) — abnormal thickening of the heart muscle

  • Congenital coronary artery anomalies

  • Arrhythmogenic cardiomyopathy

Electrical disorders

  • Long QT syndrome

  • Catecholaminergic polymorphic ventricular tachycardia

Acquired causes

  • Myocarditis

  • Drug-related arrhythmias

  • Electrolyte abnormalities

Trauma-related causes

  • Commotio cordis — ventricular arrhythmia triggered by blunt chest impact (as occurred in the case of Damar Hamlin)

Hypertrophic cardiomyopathy remains one of the most commonly identified causes in younger athletes, with an estimated prevalence of approximately 1 in 500 individuals in the general population.

The Critical Role of Immediate Response

The survival of athletes such as Hamlin demonstrates a key principle: survival depends primarily on the speed of response.

Evidence consistently shows that:

  • Immediate bystander CPR can double or triple survival rates

  • Rapid automated external defibrillator (AED) use dramatically increases the likelihood of recovery

  • Organized emergency action plans (EAPs) at sporting venues improve outcomes

Despite these facts, bystander CPR occurs only about half of the time, representing a major public-health opportunity.

Resuscitation Research Transforming Survival

Over the past two decades, NHLBI-supported research has substantially advanced cardiac arrest care.

Resuscitation Outcomes Consortium (ROC)

This major multicenter research collaboration evaluated new drugs, strategies, and technologies for cardiac arrest and trauma resuscitation, helping shape modern CPR and emergency response guidelines.

Source:
https://roc.uwctc.org

Strategies to Innovate Emergency Care Clinical Trials Network (SIREN)

SIREN builds upon ROC research and continues to conduct trials aimed at improving emergency cardiac care.

Source:
https://siren.network

ICECAP Trial

The Influence of Cooling Duration on Efficacy in Cardiac Arrest Patients (ICECAP) study evaluates optimal therapeutic hypothermia duration to improve neurologic recovery after resuscitation.

Source:
https://clinicaltrials.gov/ct2/show/NCT04217551

RACE-CARS Trial

The Randomized Cluster Evaluation of Cardiac Arrest Systems (RACE-CARS) trial examines community-level interventions to improve survival, particularly in rural and underserved areas.

Source:
https://clinicaltrials.gov/ct2/show/NCT04515030

These programs highlight a central theme: systems-level organization—training, equipment, EMS coordination—saves lives.

Preparing Athletic Programs and Communities

Every school, athletic organization, and community venue should implement a cardiac emergency preparedness strategy.

Essential preparedness steps

  1. Emergency Action Plan (EAP)

    • Clearly defined response roles

    • Rapid activation of emergency medical services (EMS)

    • Regular drills for coaches, staff, and trainers

  2. AED availability

    • AEDs accessible within 3 minutes of any athletic activity

    • Clearly marked locations

    • Routine maintenance and battery checks

  3. Universal CPR training

    • Mandatory training for coaching staff

    • Student-athlete CPR certification programs

    • Community education initiatives

  4. Pre-participation cardiovascular screening

    • Medical history

    • Physical examination

    • Targeted ECG screening where appropriate

  5. Cardiac condition registries

    • Participation in registries such as the Outcomes Registry for Cardiac Conditions in Athletes (ORCCA)

ORCCA Registry:
https://www.orccastudy.org

Barriers to Optimal Outcomes

Despite scientific advances, several barriers continue to limit survival:

Limited public CPR training

Many communities still lack widespread CPR certification programs.

Uneven AED distribution

Rural areas, community recreation centers, and underserved neighborhoods often have fewer AEDs available.

Response time disparities

Distance from hospitals and EMS response times significantly influence survival, particularly in rural regions.

Structural health disparities

Differences in healthcare access, insurance coverage, screening availability, and preventive care contribute to unequal risk and outcomes across populations.

Lack of coordinated emergency planning

Not all athletic programs have formalized emergency action plans, and many do not conduct routine drills.

The Importance of Screening and Research

Because SCA often occurs without warning symptoms, researchers continue to evaluate:

  • Optimal athlete screening strategies

  • Genetic and biologic risk predictors

  • Environmental and social determinants of risk

  • Cost-effective emergency preparedness systems

Programs supported by the NHLBI, American Heart Association, and academic sports cardiology centers continue to expand our understanding of these issues.

A Community Call to Action

The highly publicized survival of athletes following on-field cardiac arrest demonstrates what is possible when preparation meets rapid response. These events should motivate institutions, schools, and community organizations to take measurable steps to improve cardiac safety.

Communities that implement:

  • widespread CPR education,

  • universal AED placement,

  • coordinated emergency action plans,

  • and equitable access to cardiovascular screening

can significantly reduce preventable deaths from sudden cardiac arrest.

Where a cardiac arrest occurs—and how prepared a community is—should not determine whether a person lives or dies.

Key Educational Resources

Final Perspective

Sudden cardiac arrest in athletes is rare but devastating. Importantly, the science is clear: preparedness saves lives. Immediate CPR, rapid defibrillation, and organized emergency response systems dramatically improve survival. At the same time, continued research is essential to better understand the biological, environmental, and social drivers of risk—particularly the disparities observed among certain athletic populations.

The lessons learned from recent high-profile resuscitations should inspire a national commitment to cardiac emergency readiness in every school, athletic facility, and community gathering place. With training, planning, and equitable access to lifesaving resources, many sudden cardiac deaths in athletes are preventable.

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Lee Kirksey MD, MBA Vice Chair, Dept. Vascular Surgery, The Cleveland Clinic, Heart and Vascular Surgery Cleveland, OHIO