Sudden cardiac arrest on the football field of play--highlights for sports medicine from the European Resuscitation Council 2015 Consensus Guidelines.

The European Resuscitation Council (ERC) 2015 Guidelines for Resuscitation were published recently. For the first time, these guidelines included a subsection on 'cardiac arrest during sports activities' in the section dealing with cardiac arrest in special circumstances, endorsing both the importance and unique nature of this form of cardiac arrest. This paper reviews four critical areas in the management of sudden cardiac arrest in a football player: recognition, response, resuscitation and removal from the field of play. Expeditious response with initiation of immediate resuscitation at the side of a collapsed player remains crucial for survival, and chest compressions should be continued until the automated external defibrillator (AED) has been fully activated, so that the sideline medical team response to the side of a non-contact collapsed player on the field of play, with AED and defibrillation, occurs within a maximum of 2 min from collapse.

Acute hamstring strain injury in track-and-field athletes: A 3-year observational study at the Penn Relay Carnival.

This study aimed to observe the incidence rates of hamstring strain injuries (HSIs) across different competition levels and ages during the Penn Relays Carnival. Over a 3-year period, all injuries treated by the medical staff were recorded. The type of injury, anatomic location, event in which the injury occurred, competition level, and demographic data were documented. Absolute and relative HSI (per 1000 participants) were determined, and odds ratios (ORs) were calculated between sexes, competition levels, and events. Throughout the study period 48,473 athletes registered to participate in the Penn Relays Carnival, with 118 HSIs treated by the medical team. High school girls displayed lesser risk of HSI than high school boys (OR = 0.55, P = 0.021), and masters athletes were more likely than high school- (OR = 4.26, P < 0.001) and college-level (OR = 3.55, P = 0.001) athletes to suffer HSI. The 4 × 400-m relay displayed a greater likelihood of HSI compared with the 4 × 100-m relay (OR = 1.77, P = 0.008). High school boys and masters-level athletes are most likely to suffer HSI, and there is higher risk in 400-m events compared with 100-m events.

World netball cardiac screening guidelines.

Sudden cardiac adverse events remain an area of concern in sport. The precise risk for netball athletes is unknown but the annual incidence of sudden cardiac death in sports is reported at 0.5-2 cases in 100 000 young competitive athletes between the ages of 12-35 years. Cardiac screening in the sport and exercise medicine context aims at identifying pathologies associated with catastrophic events when combined with physical activity. There is an ongoing debate relating to the standardisation of the pre-participatory medical assessment (PPMA). World Netball (WN) commissioned a cardiac screening policy (13 March 2022). The minimum PPMA recommended by World Netball is a history, physical examination, and a resting 12-lead electrocardiogram (ECG). ECGs should be interpreted in accordance with athlete-specific ECG interpretation criteria. Expansion of sports cardiology experience and infrastructure, in combination with universal emergency response planning for sudden cardiac arrest, is intended to safeguard athlete health and player welfare in WN.

Automated external defibrillator use at NCAA Division II and III universities.

OBJECTIVE: The placement of automated external defibrillators (AEDs) at collegiate sporting venues is a growing trend. The purpose of this study was to investigate the prevalence, location and past utilisation of AEDs at National Collegiate Athletic Association (NCAA) Division II and III universities. DESIGN: Cross-sectional survey. SETTING: NCAA Division II and III universities. PARTICIPANTS: Questionnaires were mailed to the head athletic trainer at NCAA Division II and III (N=711) colleges and universities in the fall of 2003. Findings were compared to previously published results at Division I institutions. MAIN OUTCOME MEASURE: Prevalence, location and past utilisation of AEDs. RESULTS: Completed surveys were returned by 254 NCAA Division II and III institutions for a 35.7% response rate (254/711). 205 (81%) institutions had at least one AED in the university athletic setting, with a median of 2 AEDs per institution (range 1-9). Athletic training rooms (75%) were the most likely location to place an AED. Twelve cases of AED use for sudden cardiac arrest were reported with 67% (8/12) occurring in older non-students, 16% (2/12) in intercollegiate athletes and 16% (2/12) in students (non-intercollegiate athletes). The AED deployed a shock in eight cases. 8 of 12 (66%) victims were immediately resuscitated, but only 4 survived to hospital discharge (overall survival 33%). None of the intercollegiate athletes or students survived. CONCLUSIONS: Most NCAA Division II and III institutions that responded to the survey have implemented AEDs in their athletic programs, although they have a lower prevalence of AEDs than previously reported at Division I universities. Although no benefit was demonstrated in a small number of intercollegiate athletes, AEDs were successfully used in older individuals on campus with cardiac arrest.

Preparing for sudden cardiac arrest--the essential role of automated external defibrillators in athletic medicine: a critical review.

Sudden cardiac arrest (SCA) is the leading cause of death in exercising young athletes. Three factors-prompt recognition of SCA, the presence of a trained rescuer to initiate cardiopulmonary resuscitation (CPR) and access to early defibrillation through on-site automated external defibrillators (AEDs)-are critical to improving survival. Schools, clubs and organisations sponsoring athletic events should have an established emergency response plan for SCA. Essential elements of an emergency response plan include an effective communication system to alert first responders and retrieve the AED, training of anticipated responders in CPR and AED use, access to an AED for early defibrillation, integration of on-site AED programmes with the local emergency medical services system, and practice and review of the response plan. Timely access to AEDs at training and sporting competitions permits effective management of SCA and the prevention of sudden cardiac death in athletes. SCA should be suspected in any collapsed and unresponsive athlete and an AED applied as soon as possible for rhythm analysis and defibrillation if indicated. This article reviews emergency response planning for SCA and highlights recent data that provide a compelling case for the essential role of AEDs in the athletic setting.

Sudden cardiac arrest in children and young athletes: the importance of a detailed personal and family history in the pre-participation evaluation.

Healthcare providers have become more aware of and concerned about paediatric sudden cardiac arrest. The diseases predisposing a patient to sudden cardiac arrest are all infrequently encountered. However, a detailed and comprehensive patient and family history may reveal warning signs and symptoms that identify a patient at higher risk for sudden cardiac arrest. Since many of these diseases are genetic, extensive family evaluation may uncover a previously undetected cardiac disease process and as well direct the development of a complete family evaluation and treatment plan. Published data document that in many cases preceding warning symptoms and signs are present, but may be misinterpreted or disregarded by medical staff. Attention to the details of patient history, family history and physical exam is critical to the success of any detection strategy, which can and should be widely applied.

Sudden cardiac arrest in sports - need for uniform registration: A Position Paper from the Sport Cardiology Section of the European Association for Cardiovascular Prevention and Rehabilitation.

There are large variations in the incidence, registration methods and reported causes of sudden cardiac arrest/sudden cardiac death (SCA/SCD) in competitive and recreational athletes. A crucial question is to which degree these variations are genuine or partly due to methodological incongruities. This paper discusses the uncertainties about available data and provides comprehensive suggestions for standard definitions and a guide for uniform registration parameters of SCA/SCD. The parameters include a definition of what constitutes an 'athlete', incidence calculations, enrolment of cases, the importance of gender, ethnicity and age of the athlete, as well as the type and level of sporting activity. A precise instruction for autopsy practice in the case of a SCD of athletes is given, including the role of molecular samples and evaluation of possible doping. Rational decisions about cardiac preparticipation screening and cardiac safety at sport facilities requires increased data quality concerning incidence, aetiology and management of SCA/SCD in sports. Uniform standard registration of SCA/SCD in athletes and leisure sportsmen would be a first step towards this goal.

Sudden cardiac death in young athletes. Causes, athlete's heart, and screening guidelines.

Sudden cardiac death of a young competitive athlete is a rare but tragic event. Hypertrophic cardiomyopathy and coronary artery anomalies are the most frequent causes. Most cardiovascular abnormalities go unrecognized until the time of death owing to the lack of preceding signs or symptoms suggestive of disease. Physicians responsible for the care of athletes should be familiar with the various causes of sudden cardiac death, the physiologic adaptations seen in so-called athlete's heart, and existing cardiovascular screening guidelines. The preparticipation evaluation, although it has limitations, is the major instrument readily available for prevention of sudden cardiac death. Effort should be made to follow established consensus guidelines.

Managing low-back pain: steps to optimize function and hasten return to activity.

Low-back pain in active patients is common and often recurs. Comprehensive treatment includes control of pain and inflammation, limited bed rest, early therapeutic exercises within a pain-free range, lumbar stabilization exercises, strengthening of the muscles of the trunk and kinetic chain, aerobic conditioning, and correction of faulty biomechanics. The goal of rehabilitation is to restore normal lumbar spine function and promote independent return to activity. Normal lumbar spine function and the absence of symptoms following sport-specific skills ensure successful return to competition. A patient handout is included.

Patient adviser exercises in the treatment of low-back pain.

Exercise is an important part of treating and preventing back pain. Your doctor will show you which exercises are right for you and tell you how often, how long, and in what order you should do them. Often, relief for back pain is a goal that can only be achieved by a team approach of physician, therapist, and patient. Your full participation is essential.

Electrocardiogram interpretation in the athlete.

The sudden death of a young athlete is a devastating event that impacts the lay public and medical community and has attracted efforts to screen for underlying cardiovascular diseases associated with sudden death in this population. Electrocardiography (ECG) screening has been shown to increase the sensitivity of finding structural heart diseases in competitive athletes. Recent research in diverse populations of athletes has led to refinements in ECG-interpretation standards designed to improve its diagnostic accuracy. This review summarizes relevant information regarding cardiovascular screening and ECG interpretation in athletes.