Practical management of sudden cardiac arrest on the football field

The British Journal of Sports Medicine recently published guidelines for the management of sudden cardiac arrest (SCA) on the football (soccer) field. These guidelines are certainly applicable to all sporting events.
What are the take home points?

1. Make an Emergency Plan and make sure all coaches know this plan.
2. All coaches must know CPR and how to use an AED.
3. An AED should be at every event and coaches must know where it is!

For the complete guidelines, see below.

Key recommendations for emergency planning for sudden cardiac arrest on the football field

• Every team and venue hosting football training or competition should have a written emergency response plan for SCA.
• Potential responders to SCA on the field (ie, coaches, referees, physiotherapists, athletic trainers, and other medical staff) should be regularly trained in CPR and AED use, and demonstrate skills proficiency in this regard.
• An AED should be immediately available on the pitch during competitions.
• Both teams should review prior to the match the location of the AED and details of the emergency response plan.
• AED, automated external defibrillator; CPR, cardiopulmonary resuscitation; SCA, sudden cardiac arrest.
  Practical management of sudden cardiac arrest on the football field
  • Prompt recognition of SCA
  • SCA should be assumed in any collapsed and unresponsive athlete
  • Seizure-like activity, and abnormal breathing or gasping must be accepted as SCA until proven otherwise
  • Early activation of the emergency medical response system and call for additional rescuer assistance
  • Early CPR
  • If unresponsive and not breathing normally, begin Hands-Only (compression only) CPR—push hard, push fast
  • C−A−B (chest compressions−airway−breathing).
  • Immediate retrieval of the AED or manual defibrillator.
  • Application of the AED or manual defibrillator as soon as possible—while CPR continues. Stop CPR only for rhythm analysis and shock delivery if indicated
  • If no shock is delivered, CPR and life support measures should be continued until the player becomes responsive or a non-cardiac aetiology can be clearly established.
  • If a shock is delivered, immediately continue CPR for 2 minutes, then allow AED to reanalyse the rhythm.
  • On the discretion of the senior clinician on scene, transport of the SCA victim to a hospital facility capable of advanced cardiac life support, realising that effective CPR should be continued en route.
  • Upon return of spontaneous circulation, while still in coma, rapid cooling (induced hypothermia) for SCA victims with VF arrest has been shown to improve survival and decrease neurological complications.
  • AED, automated external defibrillator; CPR, cardiopulmonary resuscitation; SCA, sudden cardiac arrest; VF, ventricular fibrillation.
    Click here for the full study.