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Sudden Cardiac Arrest: What Schools Should Know

When a young person or adolescent dies of sudden cardiac arrest (SCA), the impact can be both frightening and devastating to the entire community.  While rare, according to the CDC, about 2,000 individuals younger than age 25 die each year of SCA in the United States and while autopsy studies have determined that most suffered from structural heart anomalies, the causes for anywhere between 6%-40% of the deaths remain unexplained. Additionally, SCA accounts for approximately 3%-5% of all deaths in children aged 5-19 years.  Lowering the risk of sudden cardiac death in young people involves educating the school community on potential risk factors that should prompt further testing, developing a cardiac emergency action plan, and training school staff on CPR and the use of an AED.

More information on policies and protocols around AEDs in the school setting, as well as educational resources for school CPR trainings and emergency action plans can be found in our 2022 blog post, “Shock Safety: AEDs in Schools”.  Outlined below are some of the most common causes of SCA in children and associated risk factors that school nurses and their communities should be aware of as part of a multi-layered mitigation system in reducing the incidence and prevalence of sudden cardiac death in young people.

Common Causes

Unlike a heart attack where blood supply to the heart muscle is cut off by a blood clot in a coronary artery, SCA often occurs in seemingly healthy, active people when the heartbeat stops abruptly and unexpectedly.  The most common causes for SCA in children typically involve heart conditions that can be inherited but that go undiagnosed until after the cardiac event.

  • Hypertrophic cardiomyopathy
  • Coronary artery abnormalities
  • Structural cardiac abnormalities
  • Arrhythmias
  • Acquired heart disease
  • Drug-induced
  • Commotio Cordis


Risk Factors

Sudden cardiac arrest can occur in children of all ages but is most frequently seen in kids 10-19 years of age.  Males are more likely than females to suffer SCA and two-thirds of the deaths caused by SCA in young people occur during exercise or physical activity.  Additional risk factors include known heart disease, arrhythmias, or structural abnormalities, as well as other conditions like obesity and hypertension.  Family history and various physical symptoms can also point to a potential risk for SCA and should be screened for as part of a child's annual health physical.

  • History of sudden death in an otherwise healthy family member before age 50
  • Family history of known heart abnormalities or other inherited cardiac conditions
  • Chest pain or fainting associated with physical activity/exercise
  • An abnormal heart rate or rhythm with no known cause


Preventing the tragedy of SCA in the pediatric population is a complex but pressing problem in which schools can play a valuable role.  Primary prevention involves education of the community to potentially identify students with risk factors associated with SCA and provide appropriate referrals for evaluation, diagnosis, plan of care, and treatment, when necessary.  Unfortunately, SCA cannot be completely prevented and that’s when a comprehensive school emergency response plan is essential for ensuring rapid recognition, effective CPR, and early defibrillation.  Schools that promote the prevention of SCA and put in place evidence-based cardiac response protocols can, and will, save lives.

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