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Sudden Cardiac Arrest

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What is sudden cardiac arrest (SCA)?

Sudden cardiac arrest (SCA) is a sudden failure of the heart to pump blood around the body when it unexpectedly stops beating. SCA usually strikes without warning at anytime, anywhere, and can affect anyone, even if they appear healthy.

Driven by the tragic death of the professional football player Marc Vivien Foé, who suffered an SCA on the pitch during the FIFA Confederations Cup 2003, FIFA implemented a number of initiatives to help prevent and raise awareness about SCA in football players. In 2006, FIFA standardised the pre-competition medical assessment (PCMA) to include the detection of cardiovascular anomalies. FIFA also provides SCA response training for referees, sport scientists, players and FIFA staff, and includes it in FIFA tournament medical workshops. In 2016, FIFA launched the free online FIFA Diploma in Football Medicine to help clinicians learn, engage, research and prevent. Two of the modules are dedicated to SCA and CPR (cardiopulmonary resuscitation). In 2018, FIFA launched a sudden cardiac arrest campaign, including an educational poster, presentations and workshops, using the popularity of football as a platform to raise awareness about this important subject in the quest to help save lives on the football pitch and among the general public.

What causes sudden cardiac death?

The causes of sudden cardiac arrest range from a variety of inborn heart muscle diseases or anomalies to viral infections of the upper respiratory tract, such as the flu, that inflame the heart muscle for about three to five days in combination with strenuous exercise during this period. Medications, drugs and stimulants may also carry considerable risk of SCA when exercising. Also possible, but very uncommon, is sudden cardiac arrest caused by an object such as the ball hitting the central chest area at a particularly vulnerable time of the heart cycle.

Signs of sudden cardiac arrest

  • Non-contact collapse:

    • Any player who collapses without having contact with another player, the ball or an obstacle should be regarded as being in SCA until proven otherwise. This collapse may be recognised by players on the field, the referee, team members located on the touchline or members of the touchline medical team who should be in attendance at all matches.
  • Unconsciousness and unresponsiveness

    • The player does not respond to any physical or verbal stimuli at all.
  • Abnormal or absent breathing

    • Players in SCA will continue to exhibit normal, rapid breathing for 90 seconds, after which their breathing becomes abnormal with gasping-type breathing, finally breathing ceases completely (apnoea). Normal breathing must not be misinterpreted; the player may still be in SCA.
  • Brief seizure-like activity or myoclonic movements

    • These slow, involuntary movements must not be mistaken for or treated initially as a seizure, as this will lead to delayed diagnosis and resuscitation.

Emergency steps to treat SCA

  • If any player or referee collapses on the pitch even though there has been no contact with another person, the ball or an obstacle, go to him or her immediately. Time is critical in this situation
  • Establish whether the player is unresponsive
  • Turn the player immediately onto his or her back, always handling the neck with care
  • Call for help using the local emergency number and request immediate assistance if there is no one else present that can help treat the player
  • There should always be an automated external defibrillator (AED) available at the training site and during matches. If, however, there is not an AED in the immediate vicinity, urgently request one
  • While someone is fetching the AED (if one is nearby) or contacting the ambulance services, begin hands-only chest compression (CPR) immediately. Do not stop chest compressions unless it is absolutely necessary, because this is what is keeping the patient alive
  • Once the AED is delivered, switch on the machine and follow all the verbal instructions given by the voice on the machine: https://www.zoll.com/medical-products/automated-external-defibrillators/aed-plus/step-by-step-demo/
  • Remember to call the emergency medical services (EMS) as quickly as possible
  • Th EMS will provide advanced cardiac life support treatment. In many tournaments,
    the touchline medical team will undertake all of the above steps in an SCA on
    the pitch.

How to help prevent SCA

  • Make a regular medical assessment of all players annually
  • Have a medical action plan for each match or training session that all first-aid and healthcare providers are aware of
  • Know how to resuscitate a player suffering an SCA on the pitch
  • Have an AED nearby, know where it is
  • Take a class in CPR
  • Education and training – it is recommended that all players, officials, referees and associated staff at football stadiums and training grounds receive basic training in CPR and AED use
  • Medical staff should closely monitor players’ health when they are experiencing a virus or infection and take appropriate measures.

Medical assessments of all players and regular medical checks

In 2006, FIFA introduced a mandatory FIFA pre-competition medical assessment (PCMA), including an electrocardiogram (ECG) and echocardiogram, if needed, with the aim of detecting serious genetic and acquired abnormal cardiac conditions. The PCMA medical examination involves obtaining a footballer’s personal and family medical history as well as conducting a physical medical examination and an ECG. A number of potentially serious heart abnormalities might not be detected during the PCMA. Therefore, it should be mandatory for all training and competition matches to have personnel available who are adequately trained to deal with SCA, can perform cardiopulmonary resuscitation (CPR) and know how to use an automated external defibrillator (AED).

What is a medical action plan?

Every school, club and organisation that is involved in football should be prepared to respond to a collapsed player who may have a cardiac emergency. A written emergency medical plan for SCA with steps that are easy to follow should be available in order to ensure an efficient and structured response. The medical action plan should be rehearsed at least once a year. Essential elements of the emergency medical plan include regular and frequent training of team members and officials and should involve:

  • the recognition of SCA;
  • how to respond on the pitch;
  • CPR and AED use (resuscitation);
  • how to summon nearby help and the emergency medical services (EMS);
  • how remove and transfer the collapsed player safely and effectively from the pitch.
  • an on-site ambulance staffed with trained crew and comprehensive medical equipment
    must be on hand at the football stadium for all matches.

Good to know

  • Quick action saves lives and survival rates could double or triple if more people take action and know what to do.
  • Sudden cardiac arrest has claimed one footballer’s life every month for the past ten years.
  • Defibrillation within 120 seconds of a player suffering SCA can increase their chance of survival to 100 %.
  • THE CPR11 app is a free download and provides clear and precise instructions about how to give CPR, use an AED and transport the player. It is available in a number of languages.

For more information go to the sudden cardiac arrest module on our FIFA Diploma in Medicine website: http://fifamedicinediploma.com/courses/sudden-cardiac-arrest/ Or contact your local member association or health centre.

Checklist for clubs and players

  • Do you undertake medical assessments of all players?

  • Do you know how to resuscitate a player suffering from SCA on the pitch? Mandatory CPR / AED SCA resuscitation training

  • Do you have a medical emergency plan?

  • Does your medical emergency plan clearly assign roles and responsibilities?

  • Do you rehearse your medical emergency plan at least once a year?

  • Does your medical emergency plan include the removal of the player from the pitch?

  • Do you have an AED and if so, where is it? Make sure it is nearby and easy to locate.

  • Do you know how to perform CPR or how to work an AED? Consider training in order to best respond to emergencies.

  • Do you have the right staff and the right equipment?

Useful links

FIFA Diploma in Medicine CPR module: http://fifamedicinediploma.com/lessons/sca-cpr/

FIFA Diploma in Medicine sudden cardiac arrest module: http://fifamedicinediploma.com/courses/sudden-cardiac-arrest/

https://www.zoll.com/medical-products/automated-external-defibrillators/aed-plus/step-by-step-demo/

CPR11 app: https://itunes.apple.com/es/app/cpr11/id938673766?l=en&mt=8

All recommendations outlined above are intended for use in FIFA tournaments only and do not constitute, and are not intended to constitute, a standard of medical care. These recommendations are not intended to be a substitute for the clinical judgment of the treating medical staff and should be interpreted based on the individual needs of the patient and the specific facts and circumstances presented.

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