On-field cardiac arrests discussed in Budapest

Michel D'Hooghe, MD Chairman of FIFA and UEFA Medical Committees, Belgium looks on during the 2nd FIFA Medical Conference
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Medical research has found the incidence of sudden cardiac arrest to be higher among professional athletes than among the normal population, and the death of Livorno player Piermario Morosini during an April match in Italy’s Serie B was just one of five incidences of sudden cardiac death on the football pitch in recent months. Therefore, it was no surprise that emergency medical care in football was one of the most hotly discussed topics at the second Medical Conference in Budapest.

On the first day of the conference, Professor Efraim Kramer from Johannesburg’s Witwersrand University delivered a presentation on first aid for paramedics in which he called for all football healthcare personnel to be given first aid training which includes football-specific CPR, and for the use of automated external defibrillators to be “non-negotiable” at all football matches, in line with the ABC principle: Automatic external defibrillator, Blow whistle, Commence match.

While team doctors are called upon to treat all manner of routine and serious on-field injuries on the pitch, it is nevertheless relatively rare that they are confronted with a cardiac incident. For many of those attending the conference, the workshop held by Kramer on the first afternoon of the conference was therefore a timely reminder how to administer CPR and use a defibrillator correctly. Kramer played video clips showing the participants the tell-tale signs of a sudden cardiac arrest, and demonstrated the CPR technique on a plastic dummy.

“Time is absolutely critical,” he explained. “You have three to five minutes to shock a normal person who has a cardiac arrest, but in a patient who has a hypertrophic cardiomyopathy (a heart muscle disease) you have about 120 seconds to get to that patient. And if you’re going to get to that patient in these two minutes to be able to shock them on the field, you have to have a plan, you have to have the equipment and you have to have people who are alert to what is happening.”

The South African cardiac specialist emphasised that CPR was only useful if followed up by the use of a defibrillator. He gave a stark but honest summary of the situation: “If there is a football match, you need a defibrillator. If you don’t have a defibrillator, you better get a coffin.”

FIFA President Joseph S. Blatter took up the theme of sudden cardiac arrests during his opening address on the second day of the conference. “In the FIFA General Secretariat, we send letters of condolences to one of the national associations practically every week because somebody has died,” he said. “If they die from old age or illness, it’s very unfortunate, but if they die on the field of play, it is our responsibility, so we have to work to avoid such things from happening.”

If there is a football match, you need a defibrillator. If you don’t have a defibrillator, you better get a coffin.

The team doctors and leading football executives who gathered in Budapest’s HungExpo for the second day of the conference also heard the story of one happy ending to an incident of sudden cardiac arrest in recent months. Bolton Wanderers midfielder Fabrice Muamba collapsed on the pitch during his team’s FA Cup match against Tottenham Hotspur in March, but thanks to the quick and effective response of everyone involved, from the pitchside medical staff to the referee, Muamba survived.

The man in the middle during that match, 2010 FIFA World Cup South Africa™ referee Howard Webb, and the Bolton team doctor Jonathan Tobin were welcomed on to the stage to answer the questions of FIFA Medical Committee chairman Dr Michel D’Hooghe and FIFA’s Chief Medical Officer Professor Jiri Dvorak, and recounted the role they played in helping to keep Muamba alive.

“The ball was out of play for a goal kick in the 41st minute,” explained Webb. “As I turned and saw Fabrice Muamba on the floor, lying face down on the floor with nobody nearby, it was clearly something that was more than a normal injury and I recognised that something would need to be done quickly to give Muamba expert medical attention. The first obligation of the referee is to protect the players.”

Webb also spoke about the value he attaches to football medicine and its practitioners: “It’s a real pleasure for someone who loves football in the way that I do to be in the presence of people who share that love for the game and use their expertise for the welfare of the participants.”

Team doctor Tobin revealed that the response training he and his colleagues had been given beforehand played an absolutely crucial role in ensuring the incident had a happy ending.

“It was obvious that something serious had happened because of the immediate reaction of the players and the reaction of Howard Webb to call for assistance,” he said. “As a doctor, you think about how you will deal with this situation in front of a live crowd and in front of television cameras. I was glad to find that the training and preparation that we undergo, the organisation, all just clicked into gear and we all knew what to do. Everyone knew where the equipment was, and the team that attended to Fabrice could progress as they’d been taught how to.”

Like Muamba, US law student Craig Hulse also survived an incident of sudden cardiac arrest, in his case while playing a match in Washington DC three years ago. He came on stage to explain how he had been saved by the quick reactions of a player on his team who had medical training.

“As soon as I mentioned my chest, he ran straight to the fire station across the street and about the time of my cardiac arrest an ambulance arrived and defibrillated me back to life on the way to the hospital,” he said. “I woke up about 24 hours later with an implanted device and the doctors told me that I had a heart disease. I’ve had corrective operations since that have taken care of it, with a very small amount of limitations to my athletic abilities going forward.”

While Hulse’s story offers encouragement to Muamba and others that a sudden cardiac arrest does not necessarily mean the end of your playing days, the American offered perhaps the most cogent reminder of why the team doctors had gathered in Budapest over the two days of the conference: “Football is life for hundreds of millions of people, but without life, there is no football.”

At the FIFA Congress in May 2012, Dvorak and D'Hooghe proposed that FIFA will offer a defibrillator to each of its Member Associations, with President Blatter in agreement.

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