Amid an outpouring of support from fans, friends and fellow athletes, experts say Bronny James and his doctors can now focus on his specific road to recovery after the older son of NBA star LeBron James suffered cardiac arrest during basketball practice Monday at the University of Southern California.
Bronny, 18, an incoming freshman for USC's basketball team, was hospitalized following the incident, and is now in stable condition and out of intensive care.
Until more is known about the cause of the incident and James' specific health condition, experts say it's hard to map out exactly what his recovery will look like, but the fact that he was treated immediately and is already out of the intensive care unit bode well for his recovery, according to Dr. Jonathan Drezner, who specializes in sports cardiology at the University of Washington Medical Center.
"The longer someone is down from cardiac arrest, the more potential damage to their heart tissue, to their brain tissue, to their body," Drezner told CNN. "A quick stay in the ICU and then a transfer to a lower level of care in a short period of time suggests that there was very little damage and is definitely a good sign."
Cardiac arrest occurs when electrical disturbances cause the heart to suddenly stop beating. These events are rare among young people, but they are not as rare among young athletes as some might think, Drezner said.
"Bronny represents the single highest athlete risk group" for sudden cardiac arrest, Drezner said.
Drezner's research on sudden cardiac arrest among young athletes shows that young, Black male, NCAA athletes who play Division I basketball have a 1 in 2,000 chance of experiencing sudden cardiac arrest each year. The risk in a male, White Division I basketball player is 1 in 5,000, according to his research.
"Adolescent male basketball players and college male basketball players, for reasons that we don't fully understand, are by far our single highest risk group of athletes for sudden cardiac arrest," said Drezner. "In my opinion, they should all be screened with more robust and intensive cardiac screening than occurs typically."
Bronny James had a cardiac screening several months ago as part of a program for prospective NBA players, according to a source familiar with the matter.
The screening included a transthoracic echocardiogram, which looks at blood flow through the heart and heart valves, and EKG, which is a recording of the heart's electrical activity, the source said, and both screenings came back with normal results.
Testing helps inform next steps
Sudden cardiac arrest can be fatal if not immediately treated, but it can be reversed by CPR and shocks from a defibrillator, according to the American Heart Association.
"Prompt rescussitation is the first, and major, major step, in terms of predicting long term recovery," Dr. Charles R. Hattemer, told CNN Wednesday. Hattemer is chief of cardiology at the University of Cincinnati Medical Center, the team that treated Damar Hamlin of the NFL's Buffalo Bills after his high-profile cardiac arrest during a game earlier this year.
More than 70% of cardiac arrests that happen outside of a hospital occur in homes or private residences, according to the American Heart Association. They say training community members in how to administer cardiopulmonary resuscitation (CPR) or use an automated external defibrillator (AED) can save lives.
"The on-site medical team rapidly evaluated the situation and appeared to respond quickly by immediately starting CPR and reportedly using a closely located AED," the American Heart Association said in a statement on James' condition.
Once a person has received immediate medical treatment and is stabilized, the next step is for doctors to perform testing to understand why the sudden cardiac arrest occurred.
Drezner said that doctors will likely perform a comprehensive evaluation on James to determine the cause of his cardiac arrest. That will help inform a management plan for his health going forward.
Many young athletes in James' situation would receive an implantable cardioverter-defibrillator (ICD), a small device placed in the chest to detect and stop irregular heartbeats.
"If they ever go into another potentially lethal arrhythmia, that defibrillator is super effective at shocking them immediately and returning their heart to a normal rhythm," Drezner said.
'There should be AEDs everywhere'
Recovery from cardiac arrest can look different for each person.
Research on sudden deaths of NCAA student athletes between 2004 and 2008 showed cardiovascular-related sudden death was the leading cause of death in 45 cases, about nine each year, according to a 2011 study.
For young athletes like James, having trained staff and an AED on site can boost the survival rate for sudden cardiac arrest to over 80%, Drezner said.
Last July, USC freshman forward Vince Iwuchukwu suffered a cardiac arrest during a summer workout. He received CPR from athletic trainers on site, who shocked him back to life. Over six months after the incident, Iwuchukwu recovered and returned to play in a game.
In January, Hamlin suffered a cardiac arrest after making a tackle and appearing to be hit by a helmet against his chest during a Monday Night Football game. Hamlin lost his pulse on the field and needed to be revived through resuscitation and defibrillation. He was hospitalized for over a week.
Hamlin said his cardiac arrest was caused by commotio cordis, when severe trauma to the chest disrupts the heart's electrical charge and causes dangerous fibrillations. He has been cleared to play again and will be a "full go" at training camp, Bills head coach Sean McDermott said Wednesday.
"The downstream, potential silver lining of these events, like Damar and Bronny, is that it raises awareness that there should be AEDs everywhere," Drezner said. "Their should be AEDs everywhere that people are playing sports and our kids are exercising."