Introduction: Sudden cardiac arrest (SCA) in sport is a tragic event. Elite footballers are at increased risk compared with the general population. The risk in non-elite but competitive individuals is unknown. Rapid response to SCA events is critical to ensure a good clinical outcome. At non-elite, competitive levels of football in the United Kingdom (UK), the availability of automated external defibrillators (AEDs), training of medical personnel in cardiopulmonary resuscitation (CPR) and AED operation has not been investigated. We sought to examine the incidence of SCA in this cohort of footballers, and the capability of clubs to screen players and respond appropriately to SCA.
Methods: Between April and September 2022, a survey was distributed to 1,301 clubs in the men’s National League System and the Women’s Football Pyramid in the UK. Club representatives were asked whether any of their players had experienced SCA at their home ground in the last 10 years and whether they had a registered player with an implantable cardioverter-defibrillator (ICD). Preparticipation screening, AED availability, medical training of club personnel and availability of an emergency action plan (EAP) were also assessed. When SCA events were identified, further details were obtained directly from the clubs.
Results: Two hundred and eighty clubs returned valid responses (response rate 21.5%), representing 10,868 footballers annually (8,846 male [81%]). Thirteen SCA events from 12 clubs were examined. SCA sufferers were all male and included 5 players. CPR was commenced in all cases and an AED was used in 11 cases. Of the 13 individuals with SCA, 7 survived, 6 following defibrillation. The SCA incidence rate in players was 1 per 21,728 person-years or 4.6 events per 100,000 athletes. Two players (40%) survived, with at least 1 player returning to play with an ICD. Preparticipation screening was performed by 14 (5%) clubs. The constituents of screening varied between clubs. Overall, 269 (96%) clubs reported possession of an AED at their home ground with 31 (11%) reporting multiple AEDs. In 237 (85%) clubs, their senior medic was trained in CPR and AED operation. However, 28 (10%) clubs did not know if their senior medics were trained, and in 12 (4%), their senior medic was not trained in CPR or AED operation. EAPs were present in 173 (62%) clubs, however 69 (24.6%) did not have an EAP and 37 (13%) did not know if the club had one. Five (2%) clubs reported a player with an ICD.
Conclusion: The SCA event rate in non-elite competitive players was comparable to elite players in the existing literature. Standardization of medical resources and personnel training is required at non-elite levels of football. The FA have proposed a rollout of minimum medical standards for clubs, commencing from the start of the 2023–24 season. Preparticipation screening was uncommon and constituents of screening were disparate. The vast majority of clubs have an AED at their home ground. Smaller majorities had EAPs in case of an SCA event or had medical personnel trained in CPR and AED operation. ❑
