The Resuscitation Council UK has released new guidelines on Resuscitation in the Field of Play. It is a sad statistic that 1 in 217,000 people per year suffer a sports-related sudden death, so it’s really important to be aware of what to do. In fact, 12 young people a week die from sudden cardiac arrest.

Whilst playing sports is generally great for your health, it is still possible for accidents to happen and for it to trigger a medical emergency.

You can read the full guidelines from the Resuscitation Council UK here.

https://www.resus.org.uk/sites/default/files/2023-12/Resuscitation%20on%20Field%20Of%20Play_0.pdf

Sudden Cardiac Arrest

What is Sudden Cardiac Arrest?

A Sudden Cardiac Arrest occurs when the heart suddenly and unexpectedly stops pumping. This is usually because the heart stops beating in regular rhythm. If this happens, blood stops flowing to the brain and other vital rogans.

Cardiac arrest is usually cause by a cardiac arrhythmia that prevents the heart beating efficiently. Cardiac arrest is a medical emergency, and the casualty will need immediate CPR and the use of an AED.

If someone has an out-of-hospital cardiac arrest, their chances of survival or making a full recovery are generally poor. Around 1 in 10 people survive to 30 days or leave hospital alive within that period.

In exercise-associated sudden cardiac arrest, rates of bystander CPR, bystander AED use and survival are substantially higher than for the general population. Therefore, there is the potential for much higher rates of survival in exercise-associated sudden cardiac arrest with prompt recognition, high-quality CPR and early defibrillation.

With a sport-relation sudden cardiac arrest this is a far greater chance of survival as the person is usually younger and relatively fit and there is more likelihood of there being trained staff and an AED readily available.

The general principles of cardiopulmonary resuscitation apply. Early recognition followed by early high-quality chest compressions and defibrillation, with either an Automated External Defibrillator (AED) or manual defibrillator, are likely to give the collapse athlete the best chance of survival.

The essential actions required for successful resuscitation, to achieve survival with a good long-term quality of life, remain unchanged. These include rapid recognition of cardiac arrest, early high-quality chest compressions with minimal interruptions and early defibrillation. Many sudden cardiac arrests will occur during recreational sport, and the prompt use of an accessible AED in these situations will have a big impact on survival. The location of AEDs should be indicated using clear signage that is visible at a distance.

Symptoms

It’s tricky to know how to spot someone suffering from sudden cardiac arrest.

If an athlete on the field of play has unexpected collapse and remains unresponsive, you should presume this is sudden cardiac arrest.

When to give CPR to a collapsed athlete

Resuscitation guidelines state that a bystander should recognise sudden cardiac arrest if a collapsed person is unresponsive and is either not breathing or not breathing normally. In the early stages of sudden cardiac arrest there may be slow, laboured breathing (agonal breathing) and/ or short episodes of seizure-like movements, which should not be allowed to delay recognition of cardiac arrest.

However, it has been observed and resported that some athletes who have had sudden cardiac arrest may continue breathing more regularly (i.e. not just agonal breaths as defined above) and/ or have their eyes open following collapse.

Athletes who have had an unexpected collapse and who remain unresponsive should be presumed to have had a sudden cardiac arrest and treated accordingly. Athletes who have had a sudden cardiac arrest may continue to gasp or have breathing movements, have seizure-like activity and have their eyes open. It is important to recognise that these signs can be present and that these athletes need immediate resuscitation. Collapse after cardiac arrest can occur during or shortly after any sporting activity and may happen away from the point of sporting action.

Sudden cardiac arrest could happen in any stage of play:

• during play – either warm-up, during play, or the post-activity recovery period.
• away from the point of sporting action.
• immediately after blunt-force trauma to the chest. This could be with another athlete, a ball or a goalpost.

It can also occur during a competition at a large venue, or at a smaller training facility.

What to do

The safety of the field-of-play medical team, the athlete and other field-of-play personnel is paramount.

Traumatic cardiac arrest is a possibility in some circumstances and field-of-play medical teams should train to appreciate and manage this occurrence.

The Resuscitation Council stresses the importance of getting medical attention as soon as possible.

You should call medical services as quickly as you can and stop play. Even if the player did not stop breathing and appears to recover from their collapse, they will still need prompt medical attention. They should not continue in their sporting activity. The athlete should be removed from the field of play for more detailed assessment in an appropriate medical facility.

Initial actions

1. Stop the play, no matter what stage the game is in.
2. Ensure the player gets medical attention as soon as possible. Make it as easy as possible for the medical services to get to them.
3. Check for breathing
4. If they are not breathing normally, start CPR and use a defibrillator immediately.
5. Continue resuscitation according to current guidelines.
6. For those athletes who have a shockable cardiac rhythm during cardiac arrest, a minimum of three shocks should be delivered on the field of play if the shockable rhythm persists. Subsequent transfer from the field of play should be well-rehearsed and there should be established protocols for onward transport to designated hospitals.

Cardiopulmonary resuscitation in more detail

Start CPR with high-quality chest compressions.

Attach a defibrillator immediately or, if one is not immediately available, as soon as it arrives. A defibrillator should be located at sports venues and training grounds so that a first shock, if appropriate, can be delivered within two minutes of the athlete’s collapse.

High-quality chest compressions should continue whilst defibrillator pads are being attached and should not pause until the defibrillator is ready to analyse the heart rhythm.

Continue with high-quality chest compressions and effective rescue breaths according to resuscitation guidelines. Provide continuous high-quality chest compressions if you are unable to give rescue breaths.

The priorities should be starting high-quality chest compressions as soon as possible, continuing these with minimal interruptions and attaching a defibrillator immediately, or as soon as it is available.

Insert a supraglottic airway (e.g. i-gel or Laryngeal Mask Airway (LMA)) and provide ventilations. If suitable equipment or expertise is not available, provide ventilations using a face mask and self-inflating bag and an oropharyngeal airway.

Effective face-mask ventilation may require a two-person technique. Attach supplemental oxygen.

You can find more information about CPR and defibrillators here. 

Preparing for the event

The Resuscitation Council stresses that medical teams should be trained to immediately recognise the signs of sudden cardiac arrest.

They need to be well-trained in what to do in the event of one. This could involve doing practice runs.

Best practice

Sports teams and organisation should consider the positive impact that successful resuscitation of high-profile athletes may have on the wider community.

There are clear opportunities to disseminate best practice and to:

• Teach people to promptly recognise sudden cardiac arrest to avoid delays to appropriate life-saving treatment.
• Emphasise that agonal breathing and brief seizure-like activity may often occur during the initial stages of sudden cardiac arrest.
• Empower people to perform bystander CPR and to use a community-based aED.
• Encourage the placement of AEDs in sporting venues and other public locations. Ideally, these should be accessible 24/7 to members of the public.

Author: Emma Hammett