You probably heard the news that Bronny James, son of LeBron James, collapsed from a cardiac arrest on the court on Monday.
No one outside of the medical team knows what happened because they haven’t released details about the case.
Anyone not on the medical team who suggests that they actually know what happened here is either lying to you or lying to themselves.
But based on what’s been reported, we can make a few inferences about this episode.
Before we get into the medical details, I can’t imagine what the James family is going through, and I am hopeful for a full and quick recovery in this case.
What is a cardiac arrest?
A cardiac arrest is when the heart is unable to pump blood to the rest of the body.
This can happen because of a primary problem with the heart (like an irregular heartbeat, a heart attack, a structural heart problem), or the response of the heart to another stressor (like low levels of oxygen or septic shock).
In someone who doesn’t have any known chronic medical conditions, a cardiac arrest caused directly by a heart problem is most likely.
In someone who has been hospitalized for a long time and has many other chronic medical issues, you can commonly see a cardiac arrest related to the other ailments someone is dealing with.
Why is a cardiac arrest a problem?
The biggest problem here is bloodflow to the brain.
When your heart isn’t pumping adequately, bloodflow to all of your organs suffers. The organ that is the most sensitive and the least able to recover is the brain.
In a cardiac arrest, it’s obviously important to get the heart started normally again as quickly as possible. But even more important is doing everything that we can to preserve bloodflow to the brain.
That’s why early CPR saves lives. Because CPR gets bloodflow to the brain and saves brain cells.
If you don’t know CPR, it’s worth knowing how to do it.
That’s why gyms, airports, schools, and shopping malls carry defibrillators.
An AED, or automated external defibrillator, can deliver a targeted jolt of electricity to restart the heart if it’s a specific type irregular heartbeat that’s caused the problem.
A crude analogy here is that of a frozen computer. Unplug it and plug it back in to get things restarted. That’s kind of how a defibrillator works.
We can infer that Bronny received prompt medical attention and had a quick recovery
The reports on this case say that the cardiac arrest happened on Monday and, by Tuesday, he was out of the intensive care unit.
This means that the medical response was excellent.
The medical staff at USC almost certainly saved his life, and if the current reports are correct, helped to ensure that he should make a full recovery.
The reason we know that his recovery was quick is that he’s out of the ICU within about 24 hours after the arrest.
That means he didn’t require hypothermia protocol (a type of whole body cooling in a prolonged cardiac arrest that helps to preserve brain function).
If someone has recovery of a pulse and their mental status is not fully intact (responding to commands, answering questions, moving all of their extremities normally), they will almost always undergo therapeutic hypothermia, a process that takes several days and requires ICU monitoring.
So if Bronny is already out of the ICU, it means he likely has total preservation of brain function.
There’s nothing we can know about why this happened
As I mentioned above, cardiac arrests happen for lots of reasons:
Structural heart problems like hypertrophic cardiomyopathy (where a lot of cardiologists mind will go when you hear about an athlete collapsing) or arrhythmogenic right ventricular cardiomyopathy
A problem with an artery to the heart that interrupts bloodflow, like a heart attack or spontaneous coronary artery dissection (SCAD)
A genetic irregular heartbeat like Brugada syndrome, long/short QT syndrome, or catecholeminergic polymorphic VT (CPVT)
Commotio cordis, a blow to the chest that causes the heart to stop (like we suspect happened to Damar Hamlin)
Not-directly-cardiac problems like a pulmonary embolism (blood clot in the lungs) or aortic dissection (tear in the major blood vessel in the chest)
He’s going to undergo a battery of tests that may help to reveal a diagnosis.
I say “may” here, because sometimes you don’t get a precise answer about what happened.
And in the situation where you don’t get a true answer, you’re left with a very difficult decision about placing a permanent defibrillator inside the body of the person who had the cardiac arrest to protect them in case of another one.
In the lucky cases, there’s something modifiable that can be fixed.
But often, if there isn’t a clear inciting external stimulus, the person who has the cardiac arrest ends up with a defibrillator, for what we call “secondary prevention of sudden cardiac death.”
Because someone is going to ask, yes, myocarditis can cause a cardiac arrest, but it’s really unlikely
I know that I’m going to get questions about the possibility this is related to Covid vaccination because there’s a corner of the internet where every case of an unexpected medical event in a young person is caused by the Covid vaccine.
I’ve written about these vaccines and myocarditis, and there’s certainly a risk/benefit analysis worth having when it comes to any medical intervention.
But if you’re considering a vaccine-related side effect, the timeline is vital to keep in mind. Almost all of the adverse vaccine events happen within the first 10-14 days after vaccination.
And so if you have a case where a patient had a vaccination months or years before, the thing that happens today is almost certainly an unrelated event.
In closing, we don’t know what happened, and we may never know what happened
If you aren’t privy to the details of a medical case, speculation about what happened isn’t going to lead to an accurate diagnosis.
When someone tells you that they know something about a medical case but they haven’t looked at the data or spoken to the patient, they’re lying to you.
Whenever someone famous gets sick, there’s a rush to judgment on social media where people with varying levels of expertise feel the need to comment on the case.
But an honest doctor will tell you the truth - when you don’t know the details, you don’t really know anything.
And so my best wishes go out to the James family. I hope for a speedy, full recovery for Bronny James.
The most productive thing you can do now is not to go down Twitter rabbit holes trying to piece together what happened. It’s to learn CPR, so that if someone around you collapses, you’ll know what to do to help.