Sports-related sudden cardiac arrest: a video analysis of presenting features, management and outcomes

Sports-related sudden cardiac arrest (SR-SCA) is the leading cause of death in athletes during sports. The objective of this study was to review all available videos worldwide of SR-SCA to better understand presenting features, management and outcomes.

A total of 48 recorded SR-SCA events were compiled through a multimedia search. Two investigators independently analysed videos to assess demographics, presenting features of SR-SCA, bystander response, management strategies and outcomes. Videos lacking sufficient data for specific variables were excluded from the statistical analysis of that specific variable(s).

Of 48 SR-SCA cases, 47 (98%) occurred in males. Most events (34; 71%) took place during low-to-moderate intensity exertion. Precollapse behaviour included stumbling 13 (27%), swaying 13 (26%), hands on knees 10 (20%) and walking 9 (18%). After collapse, among the videos where the face was visible (n=8), 100% demonstrated open eyes with fixed gaze or eyes rolled back and in cases where the chest was visible (n=31), 100% displayed continued respiratory movements or gasping after collapse. Fellow athletes did not initiate cardiopulmonary resuscitation in any competitive young athlete-victim (0/42). Early automated external defibrillator (AED) use had the strongest association with survival (19/22; 86%). Europe and North America had higher survival (26/36; 68%) and AED use (21/30; 70%) than Africa, South America and Asia (survival 0/12, 0%; AED use 1/6, 17%).

SR-SCA presents with consistent clinical features. Enhancing education on these characteristics can improve timely recognition and prompt resuscitation. Variations in survival and AED use highlight the need to strengthen awareness of SR-SCA and expand global access to AEDs.