Exclusive: Bronny James 'will likely be back to normal very soon', top USA cardiologists confirm following USC freshman's cardiac arrest
Bronny James, a freshman at University of Southern California and son of Los Angeles Lakers star LeBron James, suffered a cardiac arrest while practicing on Monday. A family spokesperson said Bronny then was taken to a nearby hospital and intensive care unit before being formally discharged.
The incident understandably sparked concern in the basketball community both among star performers and fans.
The family spokesperson said that Bronny “is now in stable condition.” Yet, uncertainty lingers on when the Trojans’ highly recruited freshman will return to play, if at all. A handful of cardiac health professionals told Sportskeeda, however, expressed optimism about Bronny’s recovery.
“The fact that Bronny’s already out of the ICU means he’s recovering quickly,” said Shephal K. Doshi, Director of the Sandra and Vin Scully Heart Rhythm Center at Providence St. Johns’ Health Center.
“I would anticipate that over the near term in the next day, two or three that he should be walking around. If his brain function is normal, he shouldn’t need to be in the hospital for more than a couple of days. But the big question about return to play depends on what we find out is the cause.”
This isn’t the first time in the past calendar year that an athlete suffered cardiac arrest.
On Jan. 2, 2023, Buffalo Bills safety Damar Hamlin collapsed on the field in a game against the Cincinnati Bengals following a nearly fatal hit to his chest that caused his heart to stop. Nearly 3 ½ months later, the Bills fully cleared Hamlin for all football activities, and he has said he plans to play.
On June 1, 2022, USC freshman center Vince Iwuchukwu suffered cardiac arrest during an informal team workout. He eventually made a full recovery and returned six months later.
As for Bronny? Neither USC nor the James’ family spokesperson offered any additional details about Bronny’s recovery, citing privacy concerns.
“LeBron and Savannah wish to publicly send their deepest thanks and appreciation to the USC medical and athletic staff for their incredible work and dedication to the safety of their athletes,” a family spokesperson said in a statement.
But three outside cardiac health professionals offered perspective to Sportskeeda on cardiac arrest, what causes it, how athletes can mitigate risk and what determines whether they can return to play. None of them treated Bronny or have access to his medical records.
The panel included:
Aaron Baggish, founder of the Cardiovascular Performance Program at the Massachusetts General Hospital Heart Center.
Sanjay Bhojraj, interventional cardiologist and triathlete that specializes in sports cardiology with Providence Mission Hospital in Southern California.
Shephal K. Doshi, Director of the Sandra and Vin Scully Heart Rhythm Center at Providence St. Johns’ Health Center
Editor’s note: The following roundtable Q&A has been edited and condensed. Their interviews with Sportskeeda were also conducted separately.
What causes a cardiac arrest?
Baggish: Typically, there is some underlying heart problem. In the majority of cases for athletes, that can cause the heart to go into an unstable heart rhythm during exercise. Then there is a significant minority of people that have a cardiac arrest with no identifiable heart problem.
It’s literally just a freak incident. Think about the heart being divided into four basic structures. There are muscles, valves, wires and arteries. There are abnormalities that people are born with or are genetic in all four of those categories. That can lead to a cardiac arrest.
That is why an athlete has to undergo a very thorough evaluation to look for this long list of problems. Testing needs to be done to look at those four components of the heart. A good medical team can help bring clarity after a cardiac arrest to explain what happened.
Bhojraj: Certainly anytime you have an athlete that suffers a cardiac arrest, it’s quite scary. These are generally people in prime athletic condition and not the traditional person you think would have a cardiac event.
Most of the times when you see events like this, as scary as they are, generally it is a treatable and reversible condition. The athletes can be treated easily after they are monitored closely. It’s most often brought on by an overexertion or electrolyte disturbances that can change the electrical function of the heart.
Doshi: Cardiac arrest is an electrical short circuit of the heart. It’s not a heart attack. That’s a blockage in the plumbing. Regardless of what causes a cardiac arrest, the heart goes through an electrical short circuit. When people are young and have a cardiac arrest, more commonly they have something genetic or something that leaves them susceptible. Some people are born with a thick heart. Those people, you would hope get screened before they play in competitive athletics. But the incidence of that is 1 out of 500 people.
To what extent can dehydration or lack of electrolytes lead to cardiac arrest?
Baggish: If there’s an underlying health problem, there’s an element of risk. Therefore, hypothermia, getting too hot or electrolyte deficiencies, stress hormones, can be the trigger on top of the problem.
Bhojraj: When you are sweating a lot, particularly in warmer weather, you can lose a lot of sodium. Sodium is what a lot of the sports drinks have with electrolytes. Sodium and potassium can get lost through sweat. Those particular electrolytes are also involved in heart activity and in the body.
If someone is exercising heavily without replacing those electrolytes, that can cause strain on the heart. That can lead to things like cardiac arrest. Most cardiac arrests that happen in a marathon happen in the latter third of a marathon because people aren’t replacing their electrolytes correctly.
There is a difference between hydration and electrolyte replication. Hydration just gives you back water. When there is a significant amount of sweat and a significant amount of loss in sodium, you have to replace that with a sports drink.
That’s where these commercial sports drinks are important for high-level athletes like Bronny.
Doshi: Athletes may be dehydrated and their electrolytes are off a little bit. But that happens all the time, and people don’t get [cardiac arrest]. For young people who have no history with this and are otherwise healthy and athletic, it’s not common that an electrolyte problem can get that bad.
Athletes other than Bronny James have had cardiac arrest. How typically does it happen to a young athlete compared to anyone else?
Baggish: The likelihood of having cardiac arrest goes up with age. Once you get above the age of 35 or 40, it happens to most people that have underlying coronary heart disease. If you’re a 65-year-old man with coronary heart disease, you’re more likely to have a cardiac arrest than if you are an otherwise healthy young athlete. It’s important to remember this happens very infrequently. But when it does, it can have catastrophic implications.
Bhojraj: The age of the athlete makes a difference. Someone like Bronny, who is a college-aged athlete, cardiac arrest is generally not from a heart attack. It’s generally from something like abnormal electrolyte levels or a rare variation of the heart. It’s common in any athlete that exerts themselves to a high degree.
It’s not specific to any sport, but rather to the age of the athlete and ensuring that they are hydrating well and balancing electrolytes and taking rest when they need to do.
Doshi: There are definitely examples. But if you think about it, considering how many people play college athletics and professionally, it’s still very rare. That’s why it’s important to see what caused the electric short circuit.
Once they do an ultrasound of his heart, they might do a cat scan of his arteries. Then they’ll have a much better understanding if they have common issues or things that are rarer.
In what ways do first responders and medical personnel alleviate such situations?
Baggish: Whenever there is a situation like the patient we’re talking about now that has resuscitated, we’re reminded of the most important part of this story. That is the availability of a prompt response with CPR. We will never stop cardiac arrests from occurring. But we can all do a much better job with being prepared when it happens.
The absence of the response confirms a 100% fatality rate. If people don’t do something, a cardiac arrest victim is not going to wake up on their own. If people do all of the right things, the odds of survival go way, way up. No response means no survival. Prompt response gives people a good chance of meaningful survival.
Bhojraj: Anywhere there is athletic activity being performed, it’s great that we have defibrillators available. This is a ‘time is of the essence’ situation. The quicker that someone can get resuscitated from a cardiac event, the greater likelihood of survival is.
It’s also important we have great reach in the community for CPR training. People who are in an athletic supervisory role – coaches, athletic directors, teammates, parents – being certified in CPR can prevent disaster and really save these kids’ lives.
Doshi: If someone doesn’t correct that cardiac arrest and fix the short circuit, usually within a few minutes, most patients will die. You have to act very rapidly to correct that. Kudos to the people that were first responders, whether it’s the athletic team or trainers at USC.
They did the one life-saving therapy you have to do within a few minutes. That’s to shock the heart back. You have to put the paddles on the chest and shock it back. Just doing CPR if someone is in cardiac arrest doesn’t fix the problem.
What happens to these people is if you don’t correct the heart fast enough, you can’t restart the heart. You have to shock the patient right away. Then the heart will recover.
Typically, what is the recovery period like for athletes that suffer a cardiac arrest?
Baggish: It all really depends on the complications or lack thereof that arise after the resuscitation. If people are worked on very quickly, their downtime is short. They can feel pretty much back to normal within a couple of days. That doesn’t necessarily mean they’re going to be back on the basketball court in a couple of days. That is more of a complicated discussion. But the response to how someone feels can be pretty quick.
First and foremost, an explanation for why the arrest occurred needs to factor in. There are conditions that we can do about them, whether medically or surgically, to make it less risky or cure it completely.
The second step involves using an implantable defibrillator, which is a device that goes into the chest to prevent cardiac arrest from happening again.
The third step involves discussing with the athlete and all the stakeholders what their wishes are with their return and if that’s appropriate. That’s what we call shared decision making where the athlete and the people important to the athlete, including family, trainers, coaches, friends, participate in a discussion on the best path forward. That’s different for every athlete.
With that, the timeline can range from no sports for the rest of the athlete’s life to a relatively quick and uncomplicated return. There are a lot of different factors that determine which of those it will be.
Bhojraj: USC has a great cardiac center. They’re going to be doing a number of tests on Bronny James to make sure his heart arteries are okay and are where they’re supposed to be. They’ll also make sure his heart valve and heart structure are okay.
Usually, they are kept out of an athletic situation for at least two weeks to let their body recover. Then they are slowly introduced to exercise. It depends on the testing. Once you find the source of the issue, the specific measure is to protect the athlete. Then it’s to prevent them from playing the sport that they love if it’s a serious enough situation.
Doshi: The fact that Bronny’s already out of the ICU means he’s recovering quickly. I would anticipate that over the near term in the next day, two or three that he should be walking around. If his brain function is normal, he shouldn’t need to be in the hospital for more than a couple of days.
But the big question about return to play depends on what we find out is the cause. Many of these patients will find out something abnormal with their heart and so they’re high risk with this happening again. In those cases, some players are told not to play because the risk is too high.
But the best-case scenario is they find a reversible cause that causes cardiac arrest. Depending on how quickly he recovers, you can wait for a period of a few weeks or a few months and then go back to play.
What mental/trauma challenges can emerge after a cardiac arrest?
Bhojraj: Depression is very common among athletes after this happens. These are people at prime peak condition and athletic ability that has this unexpected event.
Sometimes that can take a while to recover from the psychological trauma. Parents and coaches may want to restrict an athlete from exerting themselves completely for a while. That can affect athletic performance as well.
Baggish: Most athletes will not have any recall of their cardiac arrest. They will not remember any of it. That is actually a good thing. Most of them at some point will start seeing videos and hearing stories on what happened. That’s the concept with traumatic stress can be an issue. Some feel that, and some do not.
Part of the recuperation process and return to play factors into what the mental health implications are. That’s totally variable from one athlete to the next.
Doshi: It depends on how quickly they can restore flow to the brain. Sometimes, they are out of it for weeks and then eventually return to normal. Some people are out of it for a few days and hours. It depends on how quickly they resuscitated him.
It sounds like they did a fantastic job. The fact he’s already out of the ICU tells us he’s not on a ventilator. That’s a great sign. He’s young. If he recovered that quickly, he’ll likely be back to normal very soon.
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