CPR and Defibrillation in Youth Athletes with Suspected Spinal Injuries
In youth sports, the risk of sudden cardiac arrest (SCA) is rare but critical to address. Another concern in the athletic community is spinal injuries, which require careful handling to prevent further harm. When these emergencies overlap—as in the case of a youth athlete suspected of having a spinal injury during cardiac arrest—it is essential to adapt CPR and defibrillation techniques to ensure both the safety of the athlete and the efficacy of life-saving measures.
Below, we summarize key recommendations based on existing guidelines and research, including information from two cornerstone articles (Drezner et al., Kleiner et al.), to help coaches, athletic trainers, and bystanders provide effective care under these special circumstances.
Understanding the Challenges
Spinal injuries can occur during high-impact sports or activities involving falls or collisions. When an athlete with a potential spinal injury experiences cardiac arrest, the urgency of CPR and defibrillation must be balanced with the need to protect the spinal cord from further damage. Improper movement of the spine could lead to catastrophic neurological outcomes, including permanent paralysis.
Key Guidelines for CPR and Defibrillation in Suspected Spinal Injuries
1. Initial Assessment and Airway Management
According to Kleiner et al., airway management is a priority in suspected spinal injuries, but the neck and spine must be immobilized.
Use a jaw-thrust maneuver to open the airway without extending the neck. Avoid head tilt unless absolutely necessary to secure ventilation.
Ensure that cervical spine stabilization is maintained throughout the resuscitation process. If available, a second rescuer should manually stabilize the head and neck while CPR is performed.
2. Positioning for CPR
As highlighted in both articles, chest compressions should be initiated immediately if the athlete is unresponsive and has no pulse, even when a spinal injury is suspected.
If the athlete is prone (face down), and spinal injury is suspected, repositioning them to a supine (face-up) position is necessary for CPR. This should be done using a log-roll technique with the assistance of multiple rescuers to minimize spinal movement.
Face masks should be removed (leaving the helmet in place) as soon as possible to establish access to the airway
Shoulder pads should be opened or cut away (but not removed) to provide access to the chest for CPR and defibrillation
3. Defibrillation
Defibrillation remains a priority in cases of SCA. If an automated external defibrillator (AED) is available, apply it as soon as possible.
The presence of a suspected spinal injury does not delay defibrillation. Pads should be placed as directed, ensuring that the process does not exacerbate spinal instability.
Resume CPR immediately after delivering a shock, per standard resuscitation guidelines.
4. Team Coordination
Successful resuscitation in this scenario requires clear communication and teamwork. Assign roles to ensure one rescuer focuses on spinal immobilization while others perform CPR and defibrillation.
If possible, a trained medical professional or athletic trainer should take the lead in managing spinal precautions.
Special Considerations for Youth Athletes
Youth athletes may have smaller body frames, so rescuers should adjust chest compression depth and defibrillator pad placement accordingly.
Trainers and bystanders should also be aware of equipment considerations, such as removing football helmets and shoulder pads to access the chest for CPR and defibrillation while maintaining spinal immobilization. The technique for equipment removal is detailed in guidelines and should be practiced in advance.
Conclusion
CPR and defibrillation are life-saving interventions that should not be delayed, even in athletes with suspected spinal injuries. By following these specialized recommendations, bystanders and medical personnel can provide effective care while minimizing the risk of further harm. Preparation and training are key—we encourage youth sports programs to incorporate these scenarios into CPR and AED training sessions.
For more resources or to schedule a training session, visit our website at nysapaed.com. Together, we can create safer environments for young athletes and ensure prompt, effective responses to emergencies on the field.
References:
Drezner JA, Courson RW, Roberts WO, Mosesso VN Jr, Link MS, Maron BJ; Inter-Association Task Force. Inter-association task force recommendations on emergency preparedness and management of sudden cardiac arrest in high school and college athletic programs: a consensus statement. Heart Rhythm. 2007 Apr;4(4):549-65. doi: 10.1016/j.hrthm.2007.02.019. Epub 2007 Mar 1. PMID: 17399652.
Kleiner DM; Inter-Association Task Force for Appropriate Care of the Spine-Injured Athlete. Prehospital care of the spine-injured athlete: monograph summary. Clin J Sport Med. 2003 Jan;13(1):59-61. doi: 10.1097/00042752-200301000-00014. PMID: 12544168.