Detroit high school basketball player on life support protocol after cardiac arrest

Cartier Woods, a senior at Northwestern High School in Detroit, remained on a ventilator Friday in critical condition at Henry Ford Hospital after collapsing from cardiac arrest during a Tuesday night basketball game against Fredrick Douglass Academy.

“We know everyone is eager to know how Cartier is doing. It is inspiring to know how many people are praying for him and hoping he recovers,” said Chrystal Wilson, assistant superintendent of communications for Detroit Public Schools Community District.

“He continues to be on life support with small signs of improvement, but his health status has not changed significantly since Tuesday. We all ask for everyone’s continued prayers.”

Woods collapsed three minutes into the game, telling a coach he was dizzy before he fell to the floor. CPR was administered immediately, and he was taken to the hospital by ambulance.

What is the treatment protocol after sudden cardiac arrest?

Though it may be troubling to learn that Woods remains on life support three days after his sudden cardiac arrest, it’s exactly what should happen immediately following such an incident in a young athlete, said Dr. Justin Trivax, an interventional cardiologist at Corewell Health, formerly Beaumont Health.

“Post-cardiac arrest care is very specific, and it is very important to make sure that all the right boxes are being checked,” Trivax said. “The first thing is airway protection. The athlete needs to be intubated and ventilated because they've had a cardiac arrest. They need to rest, so they are put on a ventilator regardless.

“When someone says they're in the intensive care unit, they're in critical condition. Yes, they are. Because they're on a ventilator and they're sedated.”

Cooling, rewarming, lifting sedation can take a week or more

The next step is cooling the person down, inducing therapeutic hypothermia to lower the core body temperature, Trivax said.

Although he is not on the medical team treating Woods, Trivax spoke generally about the steps cardiologists follow when caring for such athletes.

“We know that the very worst thing in regard to brain recovery would be a fever or elevated core body temperature,” Trivax said. “And so therefore, almost everybody who has a cardiac arrest should undergo therapeutic hypothermia so … they have the greatest chance for neurologic recovery.”

The cooling typically lasts about 48 hours, he said. Then, physicians will slowly begin the rewarming process.

“There is a very specific protocol and there's an art to it because you want someone to be able to recover without too much sedation, but you also want to be able to assess their brain function. … And while this is ongoing, you need to start trying to figure out why this happened, putting the pieces together, because the very worst thing to have happen would be that that athlete has another major setback while they're recovering.”

Because of the cooling, gradual rewarming and the slow withdrawal of sedatives, it could be a week before doctors are able to fully assess an athlete’s brain function and have a complete picture of how well the person will recover, Trivax said.

“It’s usually a week, sometimes longer, and it’s hard for friends and families to understand that,” he said. “But this is a process and it’s going to take time to let the body heal. It’s not going to happen overnight, but the body does heal.”

What could prove vital to Woods’ survival and recovery is that coach George Tyson administered CPR immediately after he collapsed.

“The earlier a cardiopulmonary resuscitation response is initiated, the greater the chance of survival,” Trivax said. “By compressing the chest cavity, you’re moving blood around the body and you are allowing the brain to continue to function. There are vital organs that will not recover if that is not done.”

What causes a young athlete to suddenly go into cardiac arrest?

The condition is caused by an electrical malfunction, Trivax said, that leads the heart to stop pumping.

"Blood is not moved to the vital organs in the body — the brain, the kidney, the lungs. The victim will lose consciousness and will not recover unless the heart is shocked," he said.

While it's extremely rare, Trivax said, the cause usually is rooted in one of the following:

• Structural abnormalities: These are genetic or inherited heart problems. Among them is hypertrophic cardiomyopathy, which is found in about 1 in 500 people, Trivax said. It occurs when the bottom chamber of the heart gets abnormally thickened and electrical conduction does not move well through that thicker heart muscle. It can cause cardiac arrest during high levels of exercise. Another is arrhythmogenic right ventricular cardiomyopathy, which occurs when fibrous tissue and fat infiltrates the wall of the right ventricle of the heart muscle, Trivax said.
• Electrical abnormalities: These include such conditions as long QT syndrome, which occurs when the interval it takes for the heart to recharge between beats is very long, Trivax said. "If you have a beat that hits on a certain point, you can have a cardiac arrest or a ventricular fibrillation," he said. Other possibilities are Wolff-Parkinson-White syndrome, which causes a very rapid heartbeat, or Brugada syndrome.
• Acquired abnormalities: These are problems that can develop because of an exposure to toxins like performance-enhancing drugs or illicit drugs, a virus, or following blunt-force trauma to the chest, Trivax said. Among the viruses that most often are associated with myocarditis, or inflammation of the heart muscle, are coxsackievirus, parvovirus, adenovirus, coronavirus and influenza. "Any virus that you can come up with can cause an inflammation of the heart muscle and cardiac arrest," Trivax said, "we're talking something as simple as a common cold virus, adenovirus. A patient who has adenovirus may have minimal symptoms, but their immune response may be so severe and so targeted to the heart that this could cause a serious heart condition."

Although there is an association with a very slight risk of myocarditis or pericarditis following vaccination with the Pfizer and Moderna coronavirus vaccines, Trivax said those complications are rare, and those who develop heart inflammation post-vaccination overwhelmingly recover.

COVID-19 vaccine opponents on social media leap to blame sudden deaths, particularly among young people, on the vaccine.

Said Trivax: "In the peer-reviewed literature, there is no significant data available that states that an increase of cardiac arrest is occurring and that is due to the vaccination. There is just no data. When you have blogs and websites spreading this misinformation, it becomes like a wildfire and people try to latch on to it, and it's unfortunate.

"What makes these cases so hard to mentally get a grip on is that these people who are collapsing are supposed to be the existential pinnacle of health, right? They're supposed to be the healthiest people around us, and then these catastrophes occur, and it really gets us shaking our heads."

Could it be commotio cordis, suspected in Damar Hamlin's case?

Just last month, Buffalo Bills safety Damar Hamlin, 24, collapsed during a Monday Night Football game against the Cincinnati Bengals.

He also suffered cardiac arrest, was on life support and hospitalized more than a week. Hamlin was hit in the chest while making a tackle right before his heart stopped, leading some medical experts to suspect something called commotio cordis was to blame.

More:Damar Hamlin's cardiac arrest brought back scary memories for ex-Detroit Lions doctors

More:Detroit Lions back to work with Buffalo Bills S Damar Hamlin on their mind

That would be considered an acquired heart abnormality, Trivax said. Unless Woods was struck in exactly the right way at exactly the right time, it's unlikely.

"Commotio cordis is a condition where a blunt and very forceful, usually perpendicular, strike occurs to the chest wall," Trivax said. "It happens at a time on the electrocardiogram where the heart is what we call repolarizing. So it has already conducted and now it's relaxing and recharging so that it can take another beat. That's called the T-wave on the EKG.

"What happens is if you have that blunt-force trauma occur at that exact millisecond it's repolarizing, the electrical conduction in the heart goes into a ventricular fibrillation rhythm. ... This occurs in otherwise structurally normal hearts.

NHL player Chris Pronger injury in 1988

"This occurred in Detroit before this, with Chris Pronger at a Detroit Red Wings playoff game," he said.

Pronger was 23 years old and playing for the St. Louis Blues in May 1988 during the NHL's Western Conference semifinals when he was hit by a puck from a slapshot off the stick of Wings defenseman Dmitri Mironov.

He collapsed and went into sudden cardiac arrest, but his heart converted back to normal rhythm on its own. Like Woods, he was treated at Henry Ford Hospital, where it was confirmed Pronger had commotio cordis.

More:Detroit Red Wings' David Perron recalls seeing teammate collapse: 'White as ghosts'

"There is a high incidence of this in baseball because of the lack of protective covering," Trivax said, and a fast-moving ball can strike an unprotected chest at precisely the wrong time. "Lacrosse is another very common sport that we see it in and certainly things like boxing or mixed martial arts ... as well as hockey."

Screening tests can prevent sudden cardiac arrest

Simple screening tests can help doctors identify young athletes at risk for sudden cardiac arrest to prevent tragedy, Trivax said. Those tests are an electrocardiogram, commonly known as an EKG, and an echocardiogram.

Corewell Health began offering those screenings free to high school athletes in 2007.

"It shouldn't matter how many EKGs you need to do or how many echocardiograms you need to do to find one case," Trivax said. "We should only think about how we found one case. We saved one life. I feel very strongly about that."

Since that first screening at Royal Oak High School, the health system has tested the hearts of 19,701 students, according to Jennifer Shea, manager of the Beaumont Student Heart Check Program. Of them:

• 2,061 needed some sort of follow-up with a doctor.
• 223 were advised to stop playing sports until they followed up with a cardiologist. In many cases, that was because conditions such as long QT syndrome, Wolff-Parkinson-White syndrome or other congenital heart conditions were identified.
• Nine were discovered to have hypertrophic cardiomyopathy.