By: Akanksha
A nine-year-old Class 3 girl collapsed at Lovely Heritage School in Mayur Vihar, Phase 2, in East Delhi around 9:00 a.m. on Wednesday. The girl had just finished a physical training (PT) or games period. She was standing in front of her teacher when she put her hands on her waist, apparently due to tiredness, before collapsing onto her face and injuring her chin.
The class teacher ran toward her, and the girl was taken to a private hospital in Pandav Nagar by the school staff. She was then moved to Malik Hospital in Nirman Vihar, where doctors confirmed she had passed away.
School authorities stated that the girl’s death was caused by cardiac arrest. However, the family claims the school did not make prompt medical efforts or immediately perform cardiopulmonary resuscitation (CPR). The exact cause of death will be determined following a post-mortem examination.
The child can be seen walking up the stairs with her friends, as observed in the CCTV footage. As she came back from the games period, she walked into the classroom and put her hands on her waist. Suddenly, she collapsed onto her face. The class teacher ran to her and tried to get her to sit on a chair, but she appeared to be completely unresponsive. The teacher left the classroom and came back a few seconds later. The child was then taken out of the classroom for medical assistance.
The girl was taken to a private hospital in Pandav Nagar by the school staff. However, she was not admitted, and the staff were advised to take her to a better-equipped hospital. She was then transferred to Malik Hospital in Nirman Vihar.
Rajiv Kumar, Deputy Commissioner of Police (East), stated that the girl lived in Trilokpuri, and while initial findings indicate she may have suffered a cardiac event, a post-mortem will be conducted to determine the exact cause of death, according to The Indian Express. Crime and forensic experts visited the school and seized the CCTV footage.
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Bhawna Malik, the school principal, stated in an India Today report that the child was taken to the hospital immediately. She called the incident deeply regretful and said that the school takes good care of the children. According to Malik, the child suffered a cardiac arrest, collapsed inside the classroom, and was immediately rushed to the hospital, where doctors declared that she had suffered a cardiac arrest.
She also claimed there was a nurse on site. A teacher present in the classroom picked up the girl and noticed she had sustained a bleeding injury to her chin, prompting staff to rush her to the hospital. When asked why CPR was not performed, Malik replied that the staff thought her loss of consciousness was due to her chin injury.
The girl was an only child and had been attending the school since Class 1. Her father, who works as a gym trainer and an ambulance driver at Maulana Azad Medical College, stated in the India Today report that she had no known medical issues and played badminton for half an hour every day. The family said the school called them around 10:00 a.m. to inform them that she was unwell.
When they arrived at the hospital, they were told she had passed away. They claim the school lacks proper medical facilities despite charging high fees. They are questioning why CPR was not performed immediately and why she was taken to Nirman Vihar instead of closer facilities, such as Lal Bahadur Shastri (LBS) Hospital or Max Hospital.
The suspected cardiac event has not yet been established as the confirmed cause of death. School authorities attributed the incident to cardiac arrest, but post-mortem findings are required to determine the exact cause.
Cardiac arrest and a heart attack are two distinct medical emergencies, although a heart attack can sometimes trigger cardiac arrest. A heart attack occurs when blood flow to part of the heart muscle is blocked, making it a circulation problem, whereas cardiac arrest occurs when the heart's electrical system malfunctions, causing it to stop pumping blood effectively.1, 2
A person experiencing cardiac arrest suddenly becomes unresponsive and stops breathing normally or begins gasping.3 Immediate CPR and the use of an Automated External Defibrillator (AED), when indicated, are critical for survival.2,3
The suspected medical condition is pediatric sudden cardiac arrest (SCA). Peer-reviewed clinical literature indicates that while a sudden cardiac emergency in a school-aged child is rare compared to adult cases, children can harbor undetected underlying cardiovascular conditions that predispose them to sudden collapse.1, 4
Pediatric cardiac arrest occurs far less frequently than adult cardiac arrest, which is predominantly driven by coronary artery disease.4, 5 In the general pediatric population, cardiac arrest most commonly results from secondary causes such as respiratory failure, severe infection, or circulatory shock.3, 5 However, primary cardiac arrest occurring during or immediately after physical exertion in children is primarily linked to inherited cardiomyopathies and electrical channelopathies.1,6 In cardiomyopathies, genetic mutations in sarcomere and desmosomal proteins lead to myocardial ischemia and fibrosis, creating substrates that trigger fatal arrhythmias.1 Additionally, mutations in sodium, potassium, and calcium ion channels cause lethal disturbances in action potentials within morphologically normal hearts during exercise.6
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Clinical reviews and pediatric cardiology guidelines identify several primary cardiac and non-cardiac etiologies responsible for sudden cardiopulmonary collapse in children:1,4,5
Congenital Heart Defects: Structural cardiac defects or congenital coronary artery abnormalities present from birth that impair myocardial blood flow during exertion.1,4
Arrhythmias (Channelopathies): Inherited primary electrical disorders causing irregular heart rhythms, including Long QT syndrome (LQTS), Wolff-Parkinson-White (WPW) syndrome, Brugada syndrome, and Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT).1,6
Cardiomyopathy: Thickening, dilation, weakening, or stiffening of the heart muscle, most notably Hypertrophic Cardiomyopathy (HCM) and Arrhythmogenic Cardiomyopathy, which often remain asymptomatic until an acute cardiac event occurs.1,4
Myocarditis: Acute or chronic inflammation of the heart muscle typically triggered by a viral or systemic infection.1,5
Non-Cardiac Causes: Acute respiratory compromise (such as severe asthma exacerbations, pneumonia, choking, or drowning), severe systemic infections and sepsis leading to shock, anaphylaxis, and blunt chest trauma (commotio cordis).3,5
In an earlier conversation with Mariyam F. from MedBound Times, Dr. Abishek Srihari, Senior Resident in Cardiology at KMC Mangalore, Karnataka, explained that sudden symptoms and collapse should never be dismissed, as time is critical during a cardiac event.
In a true cardiac emergency, there is a crucial 'golden window' where every minute counts, making early recognition and reaching a hospital without delay extremely important," Dr. Srihari said.
He also noted that while an ambulance is ideal for providing monitoring and emergency care en route, the immediate priority when one is unavailable is getting the patient to an equipped hospital as quickly and safely as possible.
In the event of a cardiac arrest, time is critical. Resuscitation studies consistently demonstrate that immediate bystander CPR and rapid defibrillation using an AED significantly improve survival outcomes and neurological recovery in out-of-hospital pediatric arrests.2,3
If a child collapses and is found to be unresponsive and not breathing normally, or is only gasping, school staff must immediately activate emergency medical services, retrieve an AED, and initiate CPR.3 According to pediatric basic life support guidelines, lay rescuers should not delay CPR to check for a pulse in an unresponsive child who displays no signs of life.3 Chest compressions must be performed at a rate of 100 to 120 per minute to a depth of approximately 5 cm (2 inches).3 If trained, a single rescuer should perform 30 compressions followed by 2 rescue breaths, whereas two trained rescuers should utilize a 15:2 compression-to-ventilation ratio.3
Rescuers should allow complete chest recoil after each compression and minimize interruptions.3 An AED should be attached and utilized as soon as possible, using pediatric pads and a dose attenuator when appropriate.3 Furthermore, pediatric cardiology policy statements emphasize that all school staff should be trained in CPR, AEDs must be accessible on site, and regular emergency response drills should be conducted.2,4
Pediatric cardiovascular screening guidelines emphasize that parents and educators should never ignore red-flag symptoms, including unexplained fainting (syncope) or near-syncope during or immediately after exercise, exertional chest pain, palpitations, disproportionate shortness of breath, or a family history of sudden unexplained death under the age of 50.1,4
References:
Franciosi, Sonia, Dominic J. Abrams, Jodie Ingles, and Shubhayan Sanatani. "Sudden Cardiac Arrest in the Paediatric Population." CJC Pediatric and Congenital Heart Disease 1, no. 2 (2022): 45–59. https://pmc.ncbi.nlm.nih.gov/articles/PMC10642157/.
Johnson, M. Austin, Brian J. H. Grahan, Jason S. Haukoos, Bryan McNally, Robert Campbell, Comilla Sasson, and David E. Slattery. "Demographics, Bystander CPR, and AED Use in Out-of-Hospital Pediatric Arrests." Resuscitation 85, no. 7 (2014): 920–926. https://pubmed.ncbi.nlm.nih.gov/24681302/.
Topjian, Alexis A., Tia T. Raymond, Dianne Atkins, Melissa Chan, Jonathan P. Duff, Benny L. Joyner, Javier J. Lasa, et al. "Part 4: Pediatric Basic and Advanced Life Support 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care." Pediatrics 147, Suppl 1 (2021): e2020038505D. https://pubmed.ncbi.nlm.nih.gov/33081526/.
Erickson, Christopher C., Jack C. Salerno, Stuart Berger, Robert Campbell, Bryan Cannon, James Christiansen, Kody Moffatt, et al. "Sudden Death in the Young: Information for the Primary Care Provider." Pediatrics 148, no. 1 (2021): e2021052044. https://publications.aap.org/pediatrics/article/148/1/e2021052044/179969/Sudden-Death-in-the-Young-Information-for-the.
Sperotto, Francesca, Addison Gearhart, Aparna Hoskote, Peta M. A. Alexander, Jessica A. Barreto, Victoria Habet, Eleonore Valencia, and Ravi R. Thiagarajan. "Cardiac Arrest and Cardiopulmonary Resuscitation in Pediatric Patients with Cardiac Disease: A Narrative Review." European Journal of Pediatrics 182, no. 10 (2023): 4289–4308. https://pubmed.ncbi.nlm.nih.gov/37336847/.
Martínez-Barrios, Estefanía, Oscar Campuzano, Andrea Greco, José Cruzalegui, and Georgia Sarquella-Brugada. "Cardiac Channelopathies in Pediatrics: A Genetic Update." European Journal of Pediatrics 183, no. 11 (2024): 4635–4640.
(Rh/APC/MSM)
