di Sophia Palma.

CPR on the playing fieldSudden cardiac arrest (CA) in sports is defined as an unexpected event that occurs during competitive or recreational sporting activity (92% of cases), or at most within an hour of the end of the same (in the remaining 8 %). These events represent approximately 1-2% of the total sudden cardiac arrests, but acquire a high media resonance among public opinion, given that they occur in young, apparently healthy and sometimes famous subjects. It is known that if the person with AC is not resuscitated promptly within the first few minutes, death or irreversible damage to vital organs, in particular brain damage, may occur.

In the general population, in most adults and elderly subjects, AC occurs due to pathologies of the coronary arteries (acute infarction due to occlusion of a vessel), while in younger people due to structural heart diseases, such as Cardiomyopathies, or to heart diseases affecting the formation and electrical conduction in the heart (called “channelopathies”). In approximately 30% of cases the cause remains unknown.

For many years there has been an extensive debate in order to understand this phenomenon and how to resolve it. In 2022 on Journal of the American College of Cardiology Nicole Karam and collaborators have published a study reporting the evolution of the incidence, management and prognosis of AC in athletes in France, in the period between 2005 and 2018, based on data taken from the database of French National Institute of Health and Medical Research. The incidence of sudden AC in athletes has remained substantially unchanged over time (6,2 per million inhabitants per year) while the complication-free survival rate has tripled in the 13 years of observation, going from 23.8% to 66.7%.

The authors of the study hypothesize that this improvement was possible due to the active intervention in the first minutes after the event, thanks to the education of the population in cardiopulmonary resuscitation (CPR) and the use of the semi-automatic defibrillator (AED).

In the field of prevention, the use of a visit and an ECG at rest and after exercise in athletes is debated. Even if it is believed that the exclusion of athletes with suspicious ECG contributes to significantly reducing AC events, at the same time it is not a sufficient intervention to evaluate the medium-long term risk, especially in particularly demanding and long lasting. The correct screening strategy should take into account the age of the athlete, and the possibility of observing not only the ECG at rest and during maximal effort, but also the morphology and function of the heart with a color Doppler ultrasound or cardiac magnetic resonance imaging examination. , and/or of the coronary arteries with coronary CT scan. In selected subjects, the athlete can be monitored during physical effort, also using wearable instruments in order to detect any risk signals such as potentially fatal ventricular arrhythmias. All this entails a significant increase in costs both for the national health service and for the athlete.

As regards the formation of the population, it is now clear that the survival of the subject who has an AC is largely determined by the rescue carried out in the first minutes of the event itself, therefore based on correct CPR and on the presence and use of an AED. The study reported very positive data relating to the diffusion of CPR skills in France (from 34.9% in 2005 to 94.7% in 2018) and for the use of the AED (from 1.6% to 28.8%).

In conclusion, to reduce the incidence of CA and sudden cardiac death in athletes, which remained constant in France from 2005 to 2018, but with a significant increase in survival without complications, it is necessary to extend population training programs in CPR and increase the installation of AEDs.

If this happened in Italy, for example, by involving middle and high school students in training and installing AEDs in all workplaces as well as in sports, survival without complications would be improved even in the general population.