Early recognition of sudden cardiac arrest in athletes during sports activity.

Introduction: Sudden cardiac arrest (SCA) in athletes is an unexpected life-threatening event, which is often not recognised early and cardiopulmonary resuscitation (CPR) is not always initiated immediately. We describe key features to rapidly recognise non-traumatic SCA in athletes during sports activity.

Methods: We reviewed videos and images of athletes suffering from non-traumatic SCA during sports activity. We searched Google images, Google videos and YouTube.com using the keywords 'sudden cardiac death athlete' and 'resuscitation athlete'. We analysed (1) the athlete's performance before syncope, (2) the athlete's performance at the start of syncope, (3) the position of the body, and (4) the athlete's facial expressions before CPR. We analysed our data by describing these four features to answer our research question.

Results: We analysed the sequence of events in six well-known soccer players in whom a camera-witnessed non-traumatic SCA occurred during their athletic activity. All six athletes showed no changes before syncope. Four became unstable while standing and unexpectedly collapsed falling on their back. Two suddenly 'dropped dead' and fell face down. All six had their eyes wide open with a fixed gaze and fixed pupils.

Conclusions: Sudden unexpected loss of consciousness in an athlete in action and a fixed gaze eye position are key features of SCA. Immediate cardiac massage should follow. The described features to immediately recognise SCA in athletes during sports activity should be taught to everyone involved in athletic activity leading to earlier recognition of SCA followed by earlier CPR.