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Bassi MD, Farina JM, Bombau J, Fitz Maurice M, Bortman G, Nuñez E, Márquez M, Bornancini N, Baranchuk A. Sudden Cardiac Arrest in Basketball and Soccer Stadiums, the Role of Automated External Defibrillators: A Review. For the BELTRAN Study (BaskEtbaLl and soccer sTadiums: Registry on Automatic exterNal defibrillators). Arrhythm Electrophysiol Rev 2023; 12:e03. [PMID: 36845166 PMCID: PMC9945480 DOI: 10.15420/aer.2022.30] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/29/2022] [Indexed: 02/03/2023] Open
Abstract
Sudden cardiac arrest (SCA) during sports events has a dramatic impact on stadium-goers and the public and is often associated with poor outcomes unless treated with an automated external defibrillator (AED). Despite this, stadiums vary in AED use. This review aims to identify the risks and incidences of SCA, and the use of AEDs in soccer and basketball stadiums. A narrative review of all relevant papers was conducted. Athletes across all sports face an SCA risk of 1:50,000 athlete-years, with the greatest risk of SCA in young male athletes (1:35,000 person-years) and black male athletes (1:18,000 person-years). Africa and South America have the poorest soccer SCA outcomes at 3% and 4% survival. AED use on-site improves survival greater than defibrillation by emergency services. Many stadiums do not have AEDs implemented into medical plans and the AEDs are often unrecognisable or are obstructed. Therefore, AEDs should be used on-site, use clear signalling, have certified trained personnel, and be incorporated into stadiums' medical plans.
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Affiliation(s)
- Mario D. Bassi
- Department of Medicine, Kingston Health Science Centre, Queen’s University, Kingston, Ontario, Canada
| | - Juan M. Farina
- Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, Arizona, US
| | - Jorge Bombau
- Internal Medicine, National University of La Plata, Argentina
| | - Mario Fitz Maurice
- Department of Cardiology, Hospital de Agudos Bernardino Rivadavia, Buenos Aires, Argentina
| | | | - Elaine Nuñez
- Servicio de Cardiología, Cedimat Centro Cardiovascular, Santo Domingo, República Dominicana
| | - Manlio Márquez
- Department of Electrophysiology, Centro Médico ABC (American British Cowdray), Ciudad de México, México
| | - Norberto Bornancini
- Department of Cardiology, Hospital General de Agudos “General Manuel Belgrano”, Buenos Aires, Argentina
| | - Adrian Baranchuk
- Department of Medicine, Kingston Health Science Centre, Queen’s University, Kingston, Ontario, Canada,Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
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Robles AG, Palamà Z, Nesti M, Tunzi RM, Delise P, Cavarretta E, Penco M, Romano S, Sciarra L. Sport Related Sudden Death: The Importance of Primary and Secondary Prevention. J Clin Med 2022; 11:jcm11164683. [PMID: 36012921 PMCID: PMC9410008 DOI: 10.3390/jcm11164683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/20/2022] [Accepted: 08/01/2022] [Indexed: 12/02/2022] Open
Abstract
Sports are a double-edged sword. On the one hand, cardiovascular benefits from sports activity are well-known, and on the other hand, sports may increase the risk of sudden cardiac death (SCD) in subjects with known or unknown cardiovascular diseases. SCD is rare but has a very strong emotional issue. There are many examples involving famous professional athletes, but this is only scratching the surface of a widespread phenomenon that also involves amateur athletes. The importance of safely performing physical activity appears clear in both professional and amateur athletes. In particular, the former undergo a pre-participation screening for SCD primary prevention with different recommendations in each country. On the other hand, a medical examination is not mandatory for non-professional athletes and, therefore, for people who practice sports as an amateur. Widespread distribution of automatic external defibrillators and people trained for cardiopulmonary resuscitation are necessary to promote secondary prevention of SCD. We briefly report a case series of athletes with aborted SCD during sports activity in order to underline and discuss in this review the previously highlighted issues.
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Affiliation(s)
- Antonio Gianluca Robles
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Zefferino Palamà
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Martina Nesti
- Cardiovascular and Neurological Department, Ospedale San Donato, 52100 Arezzo, Italy
| | | | - Pietro Delise
- Division of Cardiology, Hospital ‘P. Pederzoli’, 37019 Peschiera del Garda, Italy
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, Italy
- Mediterranea Cardiocentro, 80122 Naples, Italy
| | - Maria Penco
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Silvio Romano
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
- Correspondence: ; Tel.: +39-0862434740; Fax: +39-0862433425
| | - Luigi Sciarra
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
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Outcome of exercise-related out-of-hospital cardiac arrest is dependent on location: Sports arenas vs outside of arenas. PLoS One 2019; 14:e0211723. [PMID: 30707745 PMCID: PMC6358107 DOI: 10.1371/journal.pone.0211723] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 01/20/2019] [Indexed: 11/19/2022] Open
Abstract
Background The chance of surviving an out-of-hospital cardiac arrest (OHCA) seems to be increased if the cardiac arrests occurs in relation to exercise. Hypothetically, an exercise-related OHCA at a sports arena would have an even better prognosis, because of an increased likelihood of bystander cardiopulmonary resuscitation (CPR) and higher availability of automated external defibrillators (AEDs). The purpose of the study was to compare survival rates between exercise-related OHCA at sports arenas versus outside of sports arenas. Methods Data from all treated exercise-related OHCA outside home reported to the Swedish Register of Cardiopulmonary Resuscitation (SRCR) from 2011 to 2014 in 10 counties of Sweden was analyzed (population 6 million). The registry has in those counties a coverage of almost 100% of all OHCAs. Results 3714 cases of OHCA outside of home were found. Amongst them, 268(7%) were exercise-related and 164 (61.2%) of those occurred at sports arenas. The 30-day survival rate was higher for exercise-related OHCA at sports arenas compared to outside (55.7% vs 30.0%, p<0.0001). OHCA-victims at sports arenas were younger (mean age±SD 57.6±16.3 years compared to 60.9±17.0 years, p = 0.05), less likely female (4.3% vs 12.2%, p = 0.02) and had a higher frequency of shockable rhythm (73.0% vs 54.3%, p = 0.004). OHCAs at arenas were more often witnessed (83.9% vs 68.9%, p = 0.007), received bystander CPR to a higher extent (90.0% vs 56.8%, p<0.0001) and the AED-use before EMS-arrival was also higher in this group (29.8% vs 11.1%, p = 0.009). Conclusion The prognosis is markedly better for exercise-related OHCA occurring at sports arenas compared to outside. Victims of exercise-related OHCA at sports arenas are more likely to receive bystander CPR and to be connected to a public AED. These findings support an increased use of public AEDs and implementation of Medical Action Plans (MAP), to possibly increase survival of exercise-related OHCA even further.
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Siebert DM, Drezner JA. Sudden cardiac arrest on the field of play: turning tragedy into a survivable event. Neth Heart J 2018; 26:115-119. [PMID: 29411289 PMCID: PMC5818383 DOI: 10.1007/s12471-018-1084-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Sudden cardiac arrest remains the leading cause of death in exercising athletes, and recent studies have shown that it occurs more frequently than historical estimates. While out-of-hospital cardiac arrest often proves fatal, advance preparation can improve outcomes and the chance of survival. First responders to a collapsed athlete on the field of play may include team medical personnel, coaches, other athletes, officials, venue staff, emergency medical services personnel, or lay bystanders. Prompt and accurate recognition of sudden cardiac arrest, a comprehensive and rehearsed emergency action plan, early cardiopulmonary resuscitation, and immediate access to and use of an automated external defibrillator are each pivotal links in the chain of survival. This review summarises the components of an effective emergency action plan, highlights the critical role of automated external defibrillators, and reviews the diagnosis and management of sudden cardiac arrest on the field of play.
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Affiliation(s)
- David M Siebert
- Department of Family Medicine, UW Medicine Center for Sports Cardiology, University of Washington, 98195, Seattle, WA, USA.
| | - Jonathan A Drezner
- Department of Family Medicine, UW Medicine Center for Sports Cardiology, University of Washington, 98195, Seattle, WA, USA
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Narayanan K, Bougouin W, Sharifzadehgan A, Waldmann V, Karam N, Marijon E, Jouven X. Sudden Cardiac Death During Sports Activities in the General Population. Card Electrophysiol Clin 2017; 9:559-567. [PMID: 29173402 DOI: 10.1016/j.ccep.2017.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Regular exercise reduces cardiovascular and overall mortality. Participation in sports is an important determinant of cardiovascular health and fitness. Regular sports activity is associated with a smaller risk of sudden cardiac death (SCD). However, there is a small risk of sports-related SCD. Sports-related SCD accounts for approximately 5% of total SCD. SCD among athletes comprises only a fraction of all sports-related SCD. Sport-related SCD has a male predominance and an average age of affliction of 45 to 50 years. Survival is better than for other SCD. This review summarizes links between sports and SCD and discusses current knowledge and controversies.
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Affiliation(s)
- Kumar Narayanan
- Paris Cardiovascular Research Center-INSERM U970 (PARCC), Paris, France; Cardiology Department, Maxcure Hospitals, Hitec City, Hyderabad 500081, India
| | - Wulfran Bougouin
- Paris Cardiovascular Research Center-INSERM U970 (PARCC), Paris, France; Paris Sudden Death Expertise Center (SDEC), European Georges Pompidou Hospital, 56 rue Leblanc, Paris 75987, France
| | - Ardalan Sharifzadehgan
- Paris Cardiovascular Research Center-INSERM U970 (PARCC), Paris, France; Paris Sudden Death Expertise Center (SDEC), European Georges Pompidou Hospital, 56 rue Leblanc, Paris 75987, France; Paris Descartes University, Rue de l'Ecole de Médecine, Paris 75006, France; Cardiology Department, European Georges Pompidou Hospital, 20, Rue Leblanc, Paris 75015, France
| | - Victor Waldmann
- Paris Cardiovascular Research Center-INSERM U970 (PARCC), Paris, France; Paris Sudden Death Expertise Center (SDEC), European Georges Pompidou Hospital, 56 rue Leblanc, Paris 75987, France; Paris Descartes University, Rue de l'Ecole de Médecine, Paris 75006, France; Cardiology Department, European Georges Pompidou Hospital, 20, Rue Leblanc, Paris 75015, France
| | - Nicole Karam
- Paris Cardiovascular Research Center-INSERM U970 (PARCC), Paris, France; Paris Sudden Death Expertise Center (SDEC), European Georges Pompidou Hospital, 56 rue Leblanc, Paris 75987, France; Paris Descartes University, Rue de l'Ecole de Médecine, Paris 75006, France; Cardiology Department, European Georges Pompidou Hospital, 20, Rue Leblanc, Paris 75015, France
| | - Eloi Marijon
- Paris Cardiovascular Research Center-INSERM U970 (PARCC), Paris, France; Paris Sudden Death Expertise Center (SDEC), European Georges Pompidou Hospital, 56 rue Leblanc, Paris 75987, France; Paris Descartes University, Rue de l'Ecole de Médecine, Paris 75006, France; Cardiology Department, European Georges Pompidou Hospital, 20, Rue Leblanc, Paris 75015, France.
| | - Xavier Jouven
- Paris Cardiovascular Research Center-INSERM U970 (PARCC), Paris, France; Paris Sudden Death Expertise Center (SDEC), European Georges Pompidou Hospital, 56 rue Leblanc, Paris 75987, France; Paris Descartes University, Rue de l'Ecole de Médecine, Paris 75006, France; Cardiology Department, European Georges Pompidou Hospital, 20, Rue Leblanc, Paris 75015, France
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Sherrid MV, Aagaard P, Serrato S, Arabadjian ME, Lium JM, Lium JD, Greenberg HM. State Requirements for Automated External Defibrillators in American Schools: Framing the Debate About Legislative Action. J Am Coll Cardiol 2017; 69:1735-1743. [PMID: 28359520 DOI: 10.1016/j.jacc.2017.01.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 12/16/2016] [Accepted: 01/10/2017] [Indexed: 12/24/2022]
Abstract
Installation of automated external defibrillators (AEDs) in schools has been associated with increased survival after sudden cardiac arrest. An authoritative academic research database was interrogated to identify all current state statutes pertaining to AEDs in schools. As of February 2016, 17 of 50 U.S. states (34%) require AED installation in at least some of their schools; the remaining states have no legislation. However, requirements are far from comprehensive in these 17 states. Only 5 states offer unequivocal funding to schools for purchasing AEDs. A minority of U.S. states have legislation requiring AED placement in schools, and even fewer provide funding. State legislatures that have not yet enacted legislation requiring AEDs in schools may look to neighboring states for examples of child and adult lifesaving law. Placement of an AED in schools should be implemented with an emergency response plan that trains staff in the recognition and response to cardiac arrest.
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Affiliation(s)
- Mark V Sherrid
- Hypertrophic Cardiomyopathy Program, New York University Langone Medical Center, New York, New York.
| | - Philip Aagaard
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Stephanie Serrato
- Hypertrophic Cardiomyopathy Program, New York University Langone Medical Center, New York, New York
| | - Milla E Arabadjian
- Hypertrophic Cardiomyopathy Program, New York University Langone Medical Center, New York, New York
| | - John M Lium
- Foundation for HCM Research at New York University, Rye, New York
| | - John D Lium
- Foundation for HCM Research at New York University, Rye, New York
| | - Henry M Greenberg
- Mailman School of Public Health, Columbia University, New York, New York
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Malhotra A, Dhutia H, Gati S, Yeo TJ, Finnochiaro G, Keteepe-Arachi T, Richards T, Walker M, Birt R, Stuckey D, Robinson L, Tome M, Beasley I, Papadakis M, Sharma S. Emergency response facilities including primary and secondary prevention strategies across 79 professional football clubs in England. Br J Sports Med 2017; 53:813-817. [DOI: 10.1136/bjsports-2016-097440] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2017] [Indexed: 11/04/2022]
Abstract
AimTo assess the emergency response planning and prevention strategies for sudden cardiac arrest (SCA) across a wide range of professional football clubs in England.MethodsA written survey was sent to all professional clubs in the English football league, namely the Premiership, Championship, League 1 and League 2. Outcomes included: (1) number of clubs performing cardiac screening and frequency of screening; (2) emergency planning and documentation; (3) automated external defibrillator (AED) training and availability; and (4) provision of emergency services at sporting venues.Results79 clubs (86%) responded to the survey. 100% clubs participated in cardiac screening. All clubs had AEDs available on match days and during training sessions. 100% Premiership clubs provided AED training to designated staff. In contrast, 30% of lower division clubs with AEDs available did not provide formal training. Most clubs (n=66; 83%) reported the existence of an emergency action plan for SCA but formal documentation was variable. All clubs in the Premiership and League 1 provided an ambulance equipped for medical emergencies on match days compared with 75% of clubs in the Championship and 66% in League 2.ConclusionsThe majority of football clubs in England have satisfactory prevention strategies and emergency response planning in line with European recommendations. Additional improvements such as increasing awareness of European guidelines for emergency planning, AED training and mentorship with financial support to lower division clubs are necessary to further enhance cardiovascular safety of athletes and spectators and close the gap between the highest and lower divisions.
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9
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d'Amati G, De Caterina R, Basso C. Sudden cardiac death in an Italian competitive athlete: Pre-participation screening and cardiovascular emergency care are both essential. Int J Cardiol 2016; 206:84-6. [PMID: 26780682 DOI: 10.1016/j.ijcard.2016.01.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 01/01/2016] [Indexed: 02/06/2023]
Affiliation(s)
- Giulia d'Amati
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Raffaele De Caterina
- Department of Neurosciences, Imaging and Clinical Sciences, University of Chieti, Chieti, Italy
| | - Cristina Basso
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
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10
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Solberg EE, Borjesson M, Sharma S, Papadakis M, Wilhelm M, Drezner JA, Harmon KG, Alonso JM, Heidbuchel H, Dugmore D, Panhuyzen-Goedkoop NM, Mellwig KP, Carre F, Rasmusen H, Niebauer J, Behr ER, Thiene G, Sheppard MN, Basso C, Corrado D. Sudden cardiac arrest in sports – need for uniform registration: A Position Paper from the Sport Cardiology Section of the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Prev Cardiol 2015; 23:657-67. [DOI: 10.1177/2047487315599891] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 07/21/2015] [Indexed: 12/16/2022]
Affiliation(s)
- EE Solberg
- Diakonhjemmet Hospital, Department of Medicine, Oslo, Norway
| | - M Borjesson
- Swedish School of Sport and Health Sciences, Stockholm, Sweden; Karolinska University Hospital
| | - S Sharma
- St George’s University of London, UK
| | | | - M Wilhelm
- University Clinic for Cardiology, Cardiovascular Prevention, Rehabilitation & Sports Medicine, Inselspital, Bern, Switzerland
| | - JA Drezner
- Department of Family Medicine, University of Washington, Seattle, USA
| | - KG Harmon
- Department of Family Medicine, University of Washington, Seattle, USA
| | - JM Alonso
- Aspetar, Qatar Orthopedics and Sports Medicine Hospital, Sports Medicine Department, Doha, Qatar
| | - H Heidbuchel
- Cardiology – Arrhythmology, University Hospital Leuven, Belgium
| | - D Dugmore
- Department of Sports medicine, Perform Sports medicine centre, Burton upon Trent, UK
| | - NM Panhuyzen-Goedkoop
- Radboud University Nijmegen MC, The Netherlands; Sports Medical Centre Papendal Arnhem, The Netherlands
| | - K-P Mellwig
- Department of Cardiology, Heart and Diabetes Centre NRW, Ruhr University of Bochum, Bad Oeynhausen, Germany
| | - F Carre
- Pontchaillou Hospital, Rennes, France; INSERM U1099, Rennes, France
| | - H Rasmusen
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - J Niebauer
- Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
| | - ER Behr
- St George’s University of London, UK
| | - G Thiene
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
| | | | - C Basso
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
| | - D Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
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Abstract
Physical activity confers substantial health benefits to healthy individuals and patients alike. Occasionally, however, exercise may act as a trigger for arrhythmic death in athletes who harbor an occult pathological substrate. The majority of sudden cardiac deaths (SCDs) in young athletes (≤35 years old) are secondary to inherited cardiac diseases, while ischaemic heart disease predominates in older athletes. In the absence of compulsory national or international registries of SCD in athletes, it is difficult to define the exact scale of the problem. In addition, the lack of post-mortem evaluation by pathologists with expertise in cardiac adaptation to exercise and inherited cardiac diseases casts doubt to the reliability of the reported causes. The proposed preventative strategies focus primarily on preventing deaths by cardiovascular evaluation of athletes and the use of automated external defibrillators in athletic venues. Cardiovascular screening of first-degree relatives, though often neglected, has the potential to avert further tragedies given the inherited nature of most conditions predisposing to SCD in the young. This article provides an overview of the epidemiology and causes of SCD in athletes and explores potential prevention strategies.
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Affiliation(s)
- Andrew D'Silva
- St George's University of London, St George's University Hospital Foundation NHS Trust, London, UK
| | - Michael Papadakis
- St George's University of London, St George's University Hospital Foundation NHS Trust, London, UK
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Søholm H, Kjaergaard J, Thomsen JH, Bro-Jeppesen J, Lippert FK, Køber L, Wanscher M, Hassager C. Myocardial infarction is a frequent cause of exercise-related resuscitated out-of-hospital cardiac arrest in a general non-athletic population. Resuscitation 2014; 85:1612-8. [DOI: 10.1016/j.resuscitation.2014.06.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 05/25/2014] [Accepted: 06/22/2014] [Indexed: 11/16/2022]
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[Cardiac arrest in spectators in German football stadiums. Precautionary measures, frequency and short-term outcome]. Anaesthesist 2014; 63:636-42. [PMID: 25047159 DOI: 10.1007/s00101-014-2354-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Provision of medical care is an important element of safety precautions for visitors of sports arenas. The organizational requirements are especially high if cardiac arrest occurs; how this scenario is managed may thus serve as the ultimate indicator of the quality of stadium medical care. The objectives of this study were to analyze the structures and the resources available for the medical care of spectators in German professional soccer stadiums and to identify the frequency and the primary resuscitation success of cardiac arrest. MATERIAL AND METHODS In 2011 a questionnaire-based survey was performed among the clubs of the first and second German soccer leagues regarding medical care of spectators during the seasons 2008/2009 and 2009/2010. The focus was on the qualifications of emergency teams, the equipment and the incidence of cardiac arrest. RESULTS A total of 15 stadiums were included (38%) in the survey. The mean number of physicians and emergency medical technicians on site was 0.6/10,000 seats and 16/10,000 seats, respectively. Of the latter, a mean of 82% (minimum 20% and maximum 100%) had received training with automatic external defibrillators. In 87% of the stadiums regular advanced life support training (ALS) was required. The mean number of defibrillators per stadium was 2.8/10,000 seats (minimum 1.3 and maximum 3.8) including 1.7 automatic defibrillators (minimum 0.4 and maximum 2.8). For patient transport, a mean of 0.65 ALS ambulance vehicles per 10,000 seats (minimum 0.14 and maximum 1.46) were available on site. In all stadiums staff members were connected via mobile radio communication with the stadium medical control room. A total of 52 cardiac arrests (=0.25/100,000 spectators) were recorded of which 96% of the patients were transported to hospitals with spontaneous circulation. CONCLUSIONS Cardiac arrests are not a rare occurrence in German soccer stadiums. The participating stadiums are overall well prepared for such incidents in terms of organization, staff and technology and due to short response times, the resuscitation success by far surpasses that of the standard emergency medical services. These findings may in addition serve as a motivational example to start resuscitation early in public information campaigns.
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14
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Abstract
A 'paradox of sport' is that in addition to the undisputed health benefits of physical activity, vigorous exertion may transiently increase the risk of acute cardiac events. In general, the risk of sudden cardiac death (SCD) approximately doubles during physical activity and is 2- to 3-fold higher in athletes compared to nonathletes. The incidence of SCD in young athletes is in fact very low, at around 1-3 per 100,000, but attracts much public attention. Variations in incidence figures may be explained by the methodology used for data collection and more importantly by differences between subpopulations of athletes. The incidence of SCD in older (≥ 35 years) athletes is higher and may be expected to rise, as more and older individuals take part in organized sports. SCD is often the first clinical manifestation of a potentially fatal underlying cardiovascular disorder and usually occurs in previously asymptomatic athletes. In the young (<35 years), SCD is mainly due to congenital/inherited cardiac abnormalities, whilst coronary artery disease (CAD) is the most common cause in older athletes. Cardiac screening including family/personal history, physical examination and resting electrocardiogram (ECG) may identify individuals at risk and has the potential to decrease the risk of SCD in young athletes. Screening including the ECG has a high sensitivity for underlying disease in young athletes, but the specificity needs to be improved, whereas the sensitivity of screening without the use of ECG is very low. The screening modality recommended for young athletes is of limited value in older athletes, who should receive individualized screening with cardiac stress testing for patients with high risk of underlying CAD. As cardiovascular screening will never be able to identify all athletes at risk, adequate preparedness is vital in case of a potentially fatal event at the sporting arena/facility. Firstly, we will review the magnitude of the problem of SCD in athletes of different ages, as well as the aetiology. Secondly, we will focus on how to prevent SCD in athletes of all ages, reviewing cardiovascular screening recommendations as well as emergency preparedness and arena safety.
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Affiliation(s)
- C Schmied
- Cardiovascular Center, Clinic for Cardiology, University Hospital Zurich, Zurich, Switzerland
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15
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Schmied C, Drezner J, Kramer E, Dvorak J. Cardiac events in football and strategies for first-responder treatment on the field. Br J Sports Med 2013; 47:1175-8. [DOI: 10.1136/bjsports-2012-091918] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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16
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Borjesson M, Serratosa L, Carre F, Corrado D, Drezner J, Dugmore DL, Heidbuchel HH, Mellwig KP, Panhuyzen-Goedkoop NM, Papadakis M, Rasmusen H, Sharma S, Solberg EE, van Buuren F, Pelliccia A. Consensus document regarding cardiovascular safety at sports arenas: Position stand from the European Association of Cardiovascular Prevention and Rehabilitation (EACPR), section of Sports Cardiology. Eur Heart J 2011; 32:2119-24. [DOI: 10.1093/eurheartj/ehr178] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Holst AG, Winkel BG, Theilade J, Kristensen IB, Thomsen JL, Ottesen GL, Svendsen JH, Haunsø S, Prescott E, Tfelt-Hansen J. Incidence and etiology of sports-related sudden cardiac death in Denmark—Implications for preparticipation screening. Heart Rhythm 2010; 7:1365-71. [DOI: 10.1016/j.hrthm.2010.05.021] [Citation(s) in RCA: 167] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Accepted: 05/12/2010] [Indexed: 11/24/2022]
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