Chapter 8 - Cardiac arrest and choking
Aims of this chapter
- Understand what a cardiac arrest is.
- Appreciate the “chain of survival” and your key role in it.
- Appreciate importance of recognising and starting cardiopulmonary resuscitation (CPR).
- Understand automated external defibrillators (AEDs).
- Understand the 2025 resuscitation guidelines, the importance of early defibrillation and minimising interruptions to chest compressions.
Basic life support
The guidelines for Basic Life Support with AED are similar throughout the World. We advise you to practice the guidelines relevant to your territory. The varied guidelines for your territory are provided in the Recognising cardiac arrest section.
Introduction
Cardiac arrest occurs when the heart stops beating. Without a heartbeat, there is no blood pressure in the circulation and so no blood is getting to the brain and other vital organs. Unless the circulation is supported using basic life support (BLS) and cardiopulmonary resuscitation (CPR or “cardiac massage”) with attempts to restart the heart (with a defibrillator), the brain will die or become severely damaged within 5-10 minutes.
BLS is the process of supporting the airway and assisting breathing and circulation without the use of equipment other than a protective face shield. Automated external defibrillators are now widely available in public places and are simple to use devices designed for people with no prior experience to deliver an electric shock to the heart in an attempt to restart it.
Cardiac arrest is a rare event in athletes. But the death of a young adult playing sport is very emotive and is high profile in the media. Recent figures suggest an incidence of up to 1 in 43,000. It is far more likely that a member of the crowd or team management will have a cardiac arrest than a player.
Nevertheless, any unwitnessed or off the ball collapse should be regarded as a potential cardiac arrest. You will do little harm by wrongly starting CPR as the player will soon wake up or move to let you know he doesn’t like what you are doing and automated defibrillators are extremely accurate in knowing whether an electric shock is needed. If there is significant delay in commencing resuscitation, then brain damage or death can occur within a few minutes.
Whilst cardiac arrests are a rare occurrence in sports people, they do happen