Sudden Cardiac Arrest in Youth Sport: The Emergency Action Plan Every Team Needs

A 16-year-old basketball player drives the lane for a layup, lands normally, takes two steps toward the bench during a timeout, and collapses. No contact. No warning. No pulse. In the next three minutes, the decisions made by the people standing around that gym will determine whether this teenager lives or dies. This is not a hypothetical scenario. It happens approximately 100 to 150 times per year in the United States among competitive young athletes, and sudden cardiac arrest (SCA) remains the number one cause of death in young athletes during sport. The survival rate without an organized response is below 10 percent. With one, it exceeds 70 percent. The difference is not talent, luck, or proximity to a hospital. It is a plan.

According to a landmark registry study by Maron et al. (2009) published in Circulation, sudden cardiac death is the leading medical cause of death in young athletes in the United States. The American Heart Association estimates the incidence at roughly 1 in 50,000 to 1 in 80,000 athletes per year. Those odds sound reassuring — until your program has 200 athletes and you realize that across a decade, you're rolling the dice. Every team, every program, every facility needs an Emergency Action Plan. This article will help you build one.

What Causes Sudden Cardiac Arrest in Young Athletes?

SCA in athletes under 35 is fundamentally different from cardiac arrest in adults. In older adults, coronary artery disease is the dominant cause. In young athletes, the causes are almost always structural or electrical abnormalities of the heart — conditions many athletes are born with but never know they have until the heart is pushed to its physiological limits during intense exercise.

The Maron registry identified the most common causes:

• Hypertrophic cardiomyopathy (HCM): The leading cause, responsible for roughly 36% of SCA cases in young athletes. The heart muscle is abnormally thick, which can disrupt electrical signals and trigger fatal arrhythmias. Many affected athletes have no symptoms and pass standard physicals without issue.
• Coronary artery anomalies: The second most common cause. The coronary arteries take an abnormal path from the aorta, and during intense exercise, the anomalous vessel can be compressed between the aorta and pulmonary artery, cutting off blood supply to the heart muscle.
• Arrhythmogenic right ventricular cardiomyopathy (ARVC): The heart muscle is progressively replaced by fatty or fibrous tissue, creating an unstable electrical substrate. This condition is particularly associated with endurance sports and is a leading cause of SCA in Italian athletes.
• Long QT syndrome: An inherited electrical disorder that prolongs the time it takes the heart to recharge between beats. Triggers include physical exertion, emotional stress, and sudden loud noises — all common in sport.
• Wolff-Parkinson-White (WPW) syndrome: An extra electrical pathway between the heart's upper and lower chambers can cause dangerously fast heart rhythms during exercise.
• Commotio cordis: A blunt blow to the chest — from a baseball, hockey puck, lacrosse ball, or even a basketball — strikes during a vulnerable 20-millisecond window of the cardiac cycle and triggers ventricular fibrillation. This accounts for roughly 3-5% of SCA in young athletes and can affect athletes with structurally normal hearts.

The Pre-Participation Screening Debate

Whether to screen young athletes with electrocardiograms (ECGs) in addition to the standard history and physical exam remains one of the most debated topics in sports medicine. The American Heart Association (AHA) recommends a 14-element history and physical exam but does not mandate ECG screening for all athletes, citing concerns about cost, false positives, and the lack of infrastructure to follow up abnormal findings. The European Society of Cardiology and the International Olympic Committee, by contrast, recommend ECG screening, pointing to Italy's experience: after implementing mandatory ECG screening in 1982, Italy saw a 90% reduction in SCA among screened athletes over 25 years, as documented by Corrado et al. (2006) in the Journal of the American Medical Association.

Regardless of where you stand on universal ECG screening, every parent should ensure their young athlete ...