On July 25, news surfaced that USC freshman Bronny James, son of Lakers superstar LeBron James, was in stable condition after collapsing from cardiac arrest during a basketball workout just one day prior.
In response to the news, an overwhelming amount of support and positivity has been sent to the James family, with the event providing perspective on the delicateness of life and what's most important.
Since the initial news was reported, each additional update on Bronny's health has been encouraging, with the latest news indicating that he had been discharged from the hospital to return home to rest and continue his recovery process, which entails quite a few steps.
To learn more about some of what Bronny may be dealing with, The Sporting News recently spoke at length with Dr. Scott Ceresnak, Cardiac Electrophysiologist and the Director of Pediatric Arrhythmia at Stanford Medicine Children’s Health, who shed light on sudden cardiac arrest in young athletes and touched on potential causes and risk factors, the steps on the road to recovery and why it is crucial to not speculate before learning more about the particular athlete's circumstance, which varies case to case.
MORE: The latest updates on Bronny James following cardiac arrest
Cardiac arrest vs. heart attack key differences
As the conversation began, Dr. Ceresnak stressed the importance of distinguishing cardiac arrest from a heart attack, which he described as "two very distinct things," adding that heart attacks are extremely unusual for patients under the age of 21. To be clear, James, 18, experienced cardiac arrest.
With respect to the distinct differences between the two events, a heart attack is when there is a blockage in one of the blood vessels supplying the heart, while Dr. Ceresnak described a cardiac arrest as "an event where the heart actually is not pumping blood adequately to provide blood to the entire body," adding that during cardiac arrest, blood isn't supplied to the body as a result of the heart not beating the way it is supposed to.
While cardiac arrest is also a rarity in young people, Dr. Ceresnak explained that it does occur within 1 in 35,000 to 40,000 NCAA athletes. And though that number still may seem low, the sheer number of young adults that participate in athletics across the NCAA's 1,000-plus member institutions means that the few annual cases align with those chances.
That likelihood again becomes greater when taking into consideration other factors that make an athlete susceptible to such an event, as cardiac arrests are more common in young males — specifically young Black males — who have been the most impacted group.
There is a myriad of potential causes for the event itself, but it is first important to recognize that while rare, James is a member of the demographic that is most impacted, that is a fact that can be determined without speculation.
With respect to James specifically, Dr. Ceresnak added that "just the fact that he survived is amazing," sharing that for out-of-hospital cardiac arrest, there is typically around a 10 percent chance for survival.
"He's in an unlucky situation in the sense that he had a really rare thing that was potentially life-threatening happen to him," Dr. Ceresnak said of James." But he's lucky in the sense that someone did CPR, saved his life, and put on an Automated External Defibrillator (AED) and brought him back."
MORE: LeBron James says 'everyone is doing great' following Bronny's cardiac arrest
The next steps in Bronny James' recovery
Per the news release from Cedars-Sinai Medical Group, James was fully conscious, neurologically intact, and stable upon his arrival at the medical center, an important update following a serious cardiac event.
The release also added that while he has returned home, James' workup will be ongoing. That workup will have an integral role in determining the next steps in James' recovery to return to normal day-to-day life and later, his path to returning to competing at an elite level.
Without specifically focusing or speculating on James' diagnoses, which are currently unknown, the purpose of the workup is to find the cause, whether it is an abnormality or a trigger that caused such an event to happen.
"In terms of what he can do going forward and how he gets back to a normal life, it really is going to depend on what his diagnosis is and what think the cause of this is," Dr. Ceresnak explained.
To avoid speculation, Dr. Ceresnak outlined that James may or may not be dealing with one of the multiple potential diagnoses, which range anywhere from structural issues with the heart to infection or Commotio Cordis, which happens when struck in the chest area.
Short-term recovery will take precedence until the workup returns, which will give an idea of what the long-term recovery will entail.
As for what the workup entails, Dr. Ceresnak mentioned that two basic-level tests include an electrocardiogram (EKG) to get a sense of the heart's electrical signals and an echocardiogram, which is a sonogram of the heart that gives an idea of the heart's anatomy of motion.
In addition to those tests, advanced testing includes a cardiac MRI, which provides a more detailed look at the heart. Through it all, there is typically extended monitoring to get a sense of what is happening with the heart's function on a day-to-day basis.
In Dr. Ceresnak's experience, there has typically been a panel of genetic testing of the patient's family members. While this testing takes weeks to return, it can give an idea of whether or not a patient is genetically predisposed to cardiac events.
"We ask parents, brothers, and sisters to undergo some routine cardiac testing," he said of the genetic testing. "So, EKG, echocardiogram, and stress test.
"Another thing would be an exercise test to look to see if we have any signs with exercise of having arrhythmias. That can be a clue. And you can look for two of the things on an exercise test."
And while this process may take several weeks to complete, it is very much a short-term process with respect to the big picture for Bronny James.
How testing impacts the long-term outlook following cardiac arrest
"The diagnosis we get really impacts what's going to happen on the next step for Bronny James in his long road to recovery," Dr. Ceresnak explained, before admitting that in a number of cases, a diagnosis is never found.
Understandably, the diagnosis that comes from the expansive testing will dictate what James can or can't do moving forward, with respect to his day-to-day life and athletic career. Though there is a varied level of risk depending on the specific diagnosis, the outlook in situations like these is much more positive than it was even a decade ago.
"This is such an intrinsic part of him," Dr. Ceresnak said of James and the game of basketball. "And there are so many great psychological benefits of sports, social benefits of sports, personal cardiovascular benefits of sports…
"…I think there are opportunities potentially for him to get back into sports to do that safely," Dr. Ceresnak continued. "Whether that’s with medications or devices that can help the heart and monitor the heart."
Conversely, there are specific diagnoses that carry greater risk and may cause medical teams to have more hesitancy in allowing Bronny to return to sports.
Without knowing the full details regarding James, it's impossible to forecast what lies down the road, but Dr. Ceresnak did explain that some of the conditions that carry heavier risks could be managed in order to facilitate a safe return to competition.
Those risks regarding what is — and isn't — safe to do moving forward will have to be sorted out by discussions held between the James family and the medical professionals that they are working with.
I think some of these diagnoses will carry some short term risk and the risk of another event happening. Some of these diagnoses will carry longer term risk, and I think that's going to come down to a few questions. Can we find the diagnosis? And then, if we can, how do you manage that risk? And how do you come to a shared decision making process with families, doctors and sports teams? Can he play again — and how much risk is that in the short term and how much risk is that in the long term?
Preparation and prevention moving forward
James' story brings important awareness to the number of student-athletes that do suffer sudden cardiac arrest in an athletic setting. While rare in terms of likelihood, it is important to acknowledge that it could inexplicably happen at any time to anyone.
Just last July, James' USC teammate, Vincent Iwuchukwu, suffered a cardiac arrest during an offseason workout but made a full recovery and returned to competing collegiately six months later with the aid of an implantable cardioverter defibrillator (ICD), a device that is implanted to make sure the heart is functioning properly at all times.
And while the events did impact two members of the same basketball program, they are separate and completely isolated. Each example, however, is a reminder of the importance of bystanders being prepared in case such an event were to transpire.
"The people who did CPR and put a defibrillator on him saved his life," Dr. Ceresnak said of the care provided for James. The same has been said about the Iwuchukwu last year.
"Part of (prevention) is talking about screening and can we prevent this from happening? But a big part of it is also teaching people to do CPR, as they saved his life. Having defibrillators saves lives."
As for screening, there's the American Heart Association's 12-step screening, which could provide a greater idea of some athletes' increased susceptibility to sudden cardiac arrest. And while that set of questions may give a better idea and other methods of pre-emptive testing exist, there is no true preventative measure at this time.
"As much as we want to screen and prevent this from happening — and my hope is we'll get better and better at preventing these," Dr. Ceresnak explained. "Right now, with all the testing we have, there's not sort of one beautiful, perfect test that can prevent this."
As advancements are continuously made in the field of cardiology, it will continue to remain important to be prepared in the case of a cardiac event. CPR and defibrillators save lives.
Note: Parts of this interview have been slightly edited for length and clarity.
