Prevention of Sudden Death Related to Sport: The Science of Basic Life Support-from Theory to Practice

Association between basic life support and survival in sports-related sudden cardiac arrest: a meta-analysis

AIMS

To evaluate the association of basic life support with survival after sports-related sudden cardiac arrest (SR-SCA).

METHODS AND RESULTS

In this systematic review and meta-analysis, a search of several databases from each database inception to 31 July 2021 without language restrictions was conducted. Studies were considered eligible if they evaluated one of three scenarios in patients with SR-SCA: (i) bystander presence, (ii) bystander cardiopulmonary resuscitation (CPR), or (iii) bystander automated external defibrillator (AED) use and provided information on survival. Risk of bias was evaluated using Risk of Bias in Non-randomized Studies of Interventions. The primary outcome was survival at the longest follow up. The meta-analysis was conducted using the random-effects model. The Grading of Recommendations Assessment, Development, and Evaluations (GRADE) approach was used to rate certainty in the evidence. In total, 28 non-randomized studies were included. The meta-analysis showed significant benefit on survival in all three groups: bystander presence [odds ratio (OR) 2.55, 95% confidence interval (CI) 1.48-4.37; I2 = 25%; 9 studies-988 patients], bystander CPR (OR 3.84, 95% CI 2.36-6.25; I2 = 54%; 23 studies-2523 patients), and bystander AED use (OR 5.25, 95% CI 3.58-7.70; I2 = 16%; 19 studies-1227 patients). The GRADE certainty of evidence was judged to be moderate.

CONCLUSION

In patients with SR-SCA, bystander presence, bystander CPR, and bystander AED use were significantly associated with survival. These results highlight the importance of witness intervention and encourage countries to develop their first aid training policy and AED installation in sport settings.

Health characteristics, knowledge, and attitude towards basic life support among marathon runners in Thailand: a population-based survey

BACKGROUND

Out-of-hospital cardiac arrest (OHCA) is not common but associated with a low survival rate. There is no evidence investigating the effects of previous Basic Life Support (BLS) training among long-distance runners. The goal of this study is to demonstrate the health characteristics, knowledge, and attitudes towards BLS among marathon runners.

METHODS

An online cross-sectional survey was asked to all 2019 Chiang Mai University marathon participants as a part of the running registration. Details of health characteristic, running history, and BLS training details were requested. The primary outcomes were knowledge and attitude towards BLS among marathon runners.

RESULTS

Of all 10,507 questionnaires sent, the response rate was 92.9%. One-nineth of participants were 50 years of age or above. The mean age was 36.8±9.9 years. Most were male (56.1%) and Thai (99.4%). Only a quarter (2454 out of 9761 runners) of study population had previous BLS training. Family history of sudden cardiac death or cardiac death with unknown causes was more in participants with previous BLS training than those without (1.1% vs. 0.6%, P=0.01). Previous BLS training group answered the national emergency call number correctly more than those without (90.4% vs. 73.0%, P<0.001) and previous BLS training group were more likely to initiate CPR than those without (median self-confidence 8 vs. 5, respectively, P<0.001).

CONCLUSIONS

Only a quarter of running participants have participated in BLS training before entering a marathon running. Having previous BLS training is associated with higher self-confidence to attempt CPR. Organized planning including trained medical staff, adequate equipment, and qualified bystanders is recommended.

Sudden cardiac death in sports: could we save Pheidippides?

Hereditary diseases under the age of 35 are the most common underlying heart disease, leading to sudden cardiac death (SCD) in competitive sports, while in older people, atherosclerotic coronary artery disease (CAD) is the main cause. The following preventive measures are recommended: (a) The pre-participation cardiovascular screening, (b) the genetic testing, (c) the use of implantable cardioverter-defibrillator (ICD), (d) the prohibition of doping in sports, (e) the prevention of 'exercise-induced' cardiac complications, (f) the reduction of high-risk factors for CAD, and (g) the use of cardiopulmonary resuscitation. The cost-effectiveness of the electrocardiograms in the pre-participation screening programs remains questionable. Genetic testing is recommended in borderline cases and positive family history. Athletes with ICD can, under certain conditions, participate in competitive sports. Excessive endurance exercise appears to harm the endothelium, promotes inflammatory processes and leads to fibrosis in the myocardium, and calcium deposition in the coronary vessels. Cardiac arrest may be reversed if cardiopulmonary resuscitation is performed and a defibrillator is immediately used. Thus, equipping all fields with automatic external defibrillators are recommended.