F-MARC: the FIFA Sudden Death Registry (FIFA-SDR)

FIFA Initiatives Improved Survival After Loss of Consciousness During Football Games

Loss of consciousness (LOC) during football games is associated with very high mortality rates. In order to address football medical emergencies, in 2013 FIFA implemented the "FIFA 11 steps to prevent sudden cardiac death" program and distributed the FIFA Medical Emergency Bag. The purpose of this work was to identify independent survival factors after LOC on the pitch and to investigate the effectiveness of the FIFA initiatives. An internet search was performed to identify football players suffering LOC on the pitch between 1990 and 2021. A total of 268 cases could be identified and were dichotomized according to the implementation date of the FIFA medical emergency bag. There was 55% mortality after LOC, while cardiogenic LOC was more often (82% vs. 20%) fatal than traumatic LOC. Mortality in developing countries was higher than in developed countries. From the year 2013 survival improved significantly for both traumatic and cardiogenic cases. The location of the LOC significantly influenced survival (OR: 0.20 and p<0.001). LOC on the football field is associated with increased mortality and requires separate monitoring based on a traumatic vs. non-traumatic cause. FIFA initiatives significantly reduced mortality after LOC but significant differences were identified between developed and developing countries.

Evolution of soccer as a research topic

Soccer has not only the largest number of worldwide participants, it is also the most studied sport, with nearly 14,000 citations listed on Pubmed and nearly 60% more articles than the next most studied sport. Research about soccer was limited until the late 1970s when exponential growth began; approximately 98% of all soccer-related research publications have occurred since 1980. This vast repository of soccer research shows trends in various major (e.g., 'sex' or 'age group' or 'performance' or 'injury') and specialty (e.g., agility, deceleration, elbow-head impact injuries, behavior) topics. Examining trends of the various topics provides insights into which subjects have come in and out of favor as well as what topics or demographics have been neglected and worthy of inquiry. A further examination can be used by students to learn the most productive researchers, which programs have a strong history of inquiry, and what journals have demonstrated a commitment to publishing research on soccer.

Cardiac arrest and sudden cardiac death registries: a systematic review of global coverage

Background

Sudden cardiac death (SCD) is a major global health problem, accounting for up to 20% of deaths in Western societies. Clinical quality registries have been shown in a range of disease conditions to improve clinical management, reduce variation in care and improve outcomes.

Aim

To identify existing cardiac arrest (CA) and SCD registries, characterising global coverage and methods of data capture and validation.

Methods

Biomedical and public search engines were searched with the terms ‘registry cardio*’; ‘sudden cardiac death registry’ and ‘cardiac arrest registry’. Registries were categorised as either CA, SCD registries or ‘other’ according to prespecified criteria. SCD registry coordinators were contacted for contemporaneous data regarding registry details.

Results

Our search strategy identified 49 CA registries, 15 SCD registries and 9 other registries (ie, epistries). Population coverage of contemporary CA and SCD registries is highly variable with registries densely concentrated in North America and Western Europe. Existing SCD registries (n=15) cover a variety of age ranges and subpopulations, with some enrolling surviving patients (n=8) and family members (n=5). Genetic data are collected by nine registries, with the majority of these (n=7) offering indefinite storage in a biorepository.

Conclusions

Many CA registries exist globally, although with inequitable population coverage. Comprehensive multisource surveillance SCD registries are fewer in number and more challenging to design and maintain. Challenges identified include maximising case identification and case verification.

Trial registration number

CRD42019118910.

Sudden cardiac arrest on the field of play: turning tragedy into a survivable event

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.

Estimating the international burden of sport-related death: a review of data sources

INTRODUCTION

Despite detailed recommendations for sports injury data capture provided since the mid-1990s, international data collection efforts for sport-related death remains limited in scope. The purpose of this paper was to review the data sources available for studying sport-related death and describe their key features, coverage, accessibility and strengths and limitations.

METHODS

The outcomes of interest for this review was death occurring as a result of participation in organised sport-related activity. Data sources used to enumerate death in sport were identified, drawing from the authors' knowledge/experience and review of key references from international organisations. The general purpose, case identification, structure, strengths and limitations of each source in relation to collection of data for sport-related death were summarised, drawing on examples from the international published literature to illustrate this application.

RESULTS

Seven types of resources were identified for capturing deaths in sport. Data sources varied considerably in their ability to identify: participant status, sport relatedness of the death, types of sport-related deaths they capture, level of detail provided about the circumstances and medical care received. The most detailed sources were those that were dedicated to sports surveillance. Sport relatedness and type of sport may not be reliably captured by systems not dedicated to sports injury surveillance. Only one source permitted international comparisons and was limited to one sport (soccer).

CONCLUSION

Data on sport-related death are currently collected across a wide variety of data sources. This review highlights the need for robust, comprehensive approaches with standardised methodologies enabling linkage between sources and international comparisons.