Resuscitation on the pitch
Neth Heart J
0 Heart Center , Radboudumc Nijmegen , The Netherlands
1 Sports Medical Centre Papendal , Arnhem , The Netherlands
2 Heart Center, Academic Medical Centre Amsterdam , Amsterdam , The Netherlands
When an athlete dies suddenly this is a very tragic event, raising media attention and a discussion on how to protect athletes. As a result more pre-participation screening is requested to identify athletes with very rare inherited cardiovascular disorders at risk of the life-threatening cardiac arrhythmia i.e. ventricular tachycardia/fibrillation (VT/VF) . The incidence of sudden cardiac death (SCD) in athletes is low (0.6-2.85/100,000 annually) [2, 3]. The annual incidences of SCD (3-10.7/100,000) and VT/VF (84.0/100,000) in the overall population are reported to be substantially higher [4, 5]. There are no comprehensive data on the incidence of out-of-hospital cardiac arrest in athletes . Pre-participation cardiovascular screening in athletes is a widely accepted method for primary prevention of SCD. Including an ECG is still a topic of debate. However, there is strong support to include an ECG routinely in pre-participation cardiovascular screening in both young and master athletes . If pre-participation screening fails, bystander resuscitation using an automatic external defibrillator (AED) is used for secondary prevention to save an athlete's life . In 2015 the European Resuscitation Council (ERC) guidelines for resuscitation (2010) were updated . The most important updated issues are an interaction of emergency medical services with the bystander performing cardiopulmonary resuscitation (CPR) and the use of an
automated external defibrillator (AED) [
]. The emergency
medical services provide telephone assistance in CPR and
the location of an AED [
]. Bystanders should be trained
and able to assess rapidly if the victim is 1) unresponsive
and 2) not breathing normally by checking the Airway (A)
and Breathing (B). These key observations are critical in
early recognition of Circulation arrest (C). Critical seconds
can be lost when this sudden circulatory arrest (SCA)
situation is not recognised immediately and time can be wasted
trying to get access to and open the airway system [
SCA (unresponsiveness and not breathing normally) CPR
should be initiated immediately with chest compressions
(depth 5–6 cm, rate 100–120 compressions/min) combined
with rescue breaths (ratio 30:2) [
]. Public access AED
programs are essential for early defibrillation. However,
the ERC guidelines do not describe CPR in athletes and
recreational sports participants.
When an athlete suddenly and unexpectedly collapses at
a training session or during a match the most obvious cause
is an underlying cardiac disorder [
]. It is very
important that such a life-threatening situation (VT/VF) is
recognised early and CPR is commenced to save the athlete’s
life . Any witness of this SCA – i. e. medical personnel,
team player, referee, spectator, or other person – should not
hesitate and start chest compressions immediately as
described by the ERC [
]. A second person is urged to fetch
an AED if available at the sport’s facility and connects the
AED to the victim without ceasing chest compressions. A
third person should call 112 (in European countries)
asking to send for an ambulance to assist CPR. In the
meantime, putting your mobile phone on the loudspeaker, 112
will guide you through the resuscitation procedure until
the ambulance personnel has arrived. When the AED says
‘rhythm analysis’ the chest compressions are briefly
interrupted. Next the AED says ‘do not touch the patient’ and
Conflict of interest N.M. Panhuyzen-Goedkoop and J.J. Piek declare
that they have no competing interests.
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