The FIFA Sudden Death Registry (FIFA-SDR) registry was created to help learn more about sudden cardiac arrest (SCA) in football. Data from this ongoing initiative has recently been reported in the BJSM.1
From 2014 to 2018 cases of sudden cardiac death (SCD), survived sudden cardiac arrest (SCA) and traumatic sudden death were recorded. This was done by a combination of strategies including media monitoring (Meltwater), the creation of a confidential web-based data platform and data synchronisation with existing national Sudden Death Registries (n=16). Over this 5-year period, a total of 617 cases of sudden death (607 football players, 4 futsal players, 4 beach soccer players and 2 walking football players) from 67 countries were identified. In 142 cases SCA was survived (23%). The mean age was 34±16 years (range 5–76 years) with the majority of cases involving male players (n=594, 96%) at the amateur level (95 %, n=584). Causes were divided into three categories: cardiovascular (82%), trauma-related (11%) and non-traumatic (7%). The majority of reported cases came from Europe (n=354, 57%) followed by South America (n=74, 12%), North America (n=64, 10%), Asia (n=49, 8%), Africa (n=39, 7%) and Australasia (n=37, 6%).
An interesting finding from this study was that when autopsies were carried out the most common finding was a structurally normal heart. This suggests that arrythmias may be the leading underlying cause of death in this cohort. Hypertrophic cardiomyopathy, the most common cause of death in other studies, was the second most common finding. It should be noted that there was some regional variation. When each continent was evaluated individually, the leading cause of death was cardiomyopathy in South America (42%) and coronary artery anomalies in North America (33%). As with previous reports, coronary artery disease was by far the most common cause of death in those who were over 35 years of age.
Perhaps the most important finding reported in this study relates to the effectiveness of CPR and early defibrillation. Disappointingly, the overall survival rate was only 23%. This improved when prompt CPR was performed by lay persons, most commonly other football players (35%) or by CPR-trained staff (50%). When an AED was also used this resulted in a survival rate of 85%. This clearly illustrates the need for ongoing education and promotion of CPR and AED use in football and the potential life-saving impact of this type of work.
A major limitation of this study relates to the ability to identify cases. This is reflected in the preponderance of European players seen in the sample. Ongoing efforts are needed to educate clinicians, and the football playing public, to ensure appropriate treatment and also reporting events.
1. Egger F, Scharhag J, Kästner A, et al. FIFA Sudden Death Registry (FIFA-SDR): a prospective, observational study of sudden death in worldwide football from 2014 to 2018. British Journal of Sports Medicine Published Online First: 23 December 2020. doi: 10.1136/bjsports-2020-102368