Objectives. Starting from video analysis of athletes collapse during physical activity, our study tries to understand if there are some predictors of a fainting attributed to a cardiac arrest or not, aims to recognize the characteristics of a SCA, evaluating the importance of using the automatic external defibrillator (AED) and identify, when possible, different factors capable of influence the outcomes of a SCA during elite or amateur sport events. Methods and Data. Public videos and recordings, online web available with appropriate image quality and suitable duration, containing SCA events occurred to athletes have been evaluated by a team of international experts. We have analyzed 50 different “on court” SCA videographic testimony of as many professional or amateur athletes (including three professional referees), occurred in the period between 1990 and 2024 and grouped into 10 different sport activities: Football (23), Ice Hockey (8), Basketball (6), Martial Arts (3), Professional referees (3), American Football (2), Cricket (2), Badminton (1), Volleyball (1), school physical education (1). Video analysis was made focusing on athlete’s behavior pre/during/post collapse, other athletes’ reaction, time from collapse to first aid, type of aid (and its correctness), time intervals of CPR, time intervals of AED positioning and first shock, number of AED shocks, survival and SCA causal cardiac diagnosis when possible. Results of a preliminary analysis were compared between different participants of the study for the purpose of objectifying collected data. Statistical analysis was made using Fisher X2 Test with all the variables settled and examinated for survival outcome. Results. From the analysis of 50 different video and cases (among which 29 survived and 21 deceased), it is confirmed that the majority of SCA occur during light or moderate physical activity (70%), corroborating the data from previous studies. The place in which the sudden cardiac arrest occurs appears to significantly influence the outcome (p<0.01) with a positive increase in expected survival for cases located in North America and Europe and a drastic decrease for cases located elsewhere continents. The ethnicity of the victim suffering from cardiac arrest seems to significantly influence the survival outcome (p<0,01), either positively (when “Caucasian”) or negatively (“Asian” and “Latino-American”) depending on the conditions, but this could represent an epiphenomenon of the geographic region where the sporting event was recorded especially considering that the only “non-Caucasian” subjects who survived cardiac arrest were in Europe or North America at the time of the event. Moreover, the study of pre-collapse and during collapse victim behavior, provided us results regarding athlete’s attitude right before the SCA collapse, pointing the position of the hands over the knees as related to a poor survival outcome (p<0,05). Among the additional factors determining a statistically significant difference between expected and observed outcomes are the implementation of proper emergency aid by the first responder (p<0,01) to the athlete and the timely and appropriate use of the AED (p<0,05). Conclusion. The correct implementation of cardiopulmonary resuscitation in sportive context, the identification of preliminary sign of cardiac collapse and the earlier use of an AED in case of SCA improve survival rates even in cases of athletes, whether these are amateurs or professionals.
Obiettivi. Partendo dall’analisi video del collasso di atleti durante l’attività fisica questo studio: tenta di comprendere se esistono alcuni predittori di collasso attribuibili ad arresto cardiaco o meno, si propone di riconoscere le caratteristiche di un arresto cardiaco improvviso valutando l’importanza dell’utilizzo di defibrillatori automatici esterni (DAE) e identifica, quando possibile, differenti fattori in grado di influenzare l’outcome di un arresto cardiaco durante eventi sportivi amatoriali o professionali. Materiali e Metodi. Videoregistrazioni pubbliche, liberamente disponibili online, con immagini di adeguata qualità e adatta durata contenenti eventi di arresto cardiaco improvviso occorso a un partecipante ad un evento sportivo, valutate in team da un gruppo di lavoro internazionale. Sono stati analizzati 50 differenti testimonianze videografiche di arresti cardiaci improvvisi “in campo”, riguardanti atleti professionisti o amatoriali (includendo anche 3 casi di arbitri professionisti), verificatisi tra il 1990 e il 2024 e raggruppati in 10 differenti attività sportive: Calcio (23), Hockey (8), Pallacanestro (6), Arti Marziali (3), Arbitri (3), Football Americano (2), Cricket (2), Badminton (1), Pallavolo (1), Educazione fisica (1). L’analisi video è stata fatta focalizzandosi su: comportamento dell’atleta prima, durante e dopo il collasso, reazioni degli altri atleti, intervallo tra collasso e arrivo del primo soccorso, tipologia di soccorso (e sua correttezza), intervallo tra collasso e inizio della RCP, intervallo tra collasso e arrivo del DAE e prima scarica, numero di scariche DAE, sopravvivenza e determinazione delle cause di arresto cardiaco improvviso quando possibile. I risultati di un’analisi preliminare sono stati confrontati tra i diversi membri dello studio al fine di oggettivare i risultati ottenuti. L’analisi statistica è stata fatta utilizzando il Test di Fischer del Chi2 per tutte le variabili organizzate ed esaminate in funzione dell’outcome. Risultati. Dall’analisi di 50 casi (29 soggetti sopravvissuti e 21 soggetti deceduti) si conferma che la maggioranza degli arresti cardiaci improvvisi insorgono durante un’attività fisica di lieve o moderata intensità (70% dei casi totali) confermando così i dati di studi precedenti. Il luogo in cui si verifica l’arresto cardiaco improvviso sembra influenzare in maniera significativa l’outcome (p<0,01) con un aumento positivo della sopravvivenza attesa nei casi localizzati in Nord America ed Europa e un drastico calo nei casi localizzati negli altri continenti. L’etnia del soggetto vittima di arresto sembra influenzare in maniera significativa (p<0,01), positivamente (“etnia caucasica”) o negativamente (“etnia asiatica” e “etnia latinoamericana”) in base alle condizioni, l’outcome ma ciò sembra essere un epifenomeno della regione geografica in cui si svolge l’evento sportivo soprattutto considerando che gli unici soggetti “non-caucasici” sopravvissuti all’arresto cardiaco si trovavano in Europa o Nord America al momento dell’evento. I fattori determinanti una differenza statisticamente significativa tra outcome atteso e outcome osservato risultano essere la messa in atto di un corretto soccorso da parte del primo soccorritore (p<0,01) e l’utilizzo appropriato e tempestivo del defibrillatore per ripristinare la funzione cardiaca (p<0,05). Conclusioni. La corretta implementazione della rianimazione cardiopolmonare in contesto sportivo, l’identificazione dei segni anticipatori di collasso per cause cardiache e l’utilizzo precoce del DAE in caso di arresto cardiaco migliorano il tasso di sopravvivenza negli atleti sia di livello amatoriale che professionale.
Analisi delle circostanze e dell'outcome degli arresti cardiaci videoregistrati di atleti
CANIGLIA, ANDREA
2023/2024
Abstract
Objectives. Starting from video analysis of athletes collapse during physical activity, our study tries to understand if there are some predictors of a fainting attributed to a cardiac arrest or not, aims to recognize the characteristics of a SCA, evaluating the importance of using the automatic external defibrillator (AED) and identify, when possible, different factors capable of influence the outcomes of a SCA during elite or amateur sport events. Methods and Data. Public videos and recordings, online web available with appropriate image quality and suitable duration, containing SCA events occurred to athletes have been evaluated by a team of international experts. We have analyzed 50 different “on court” SCA videographic testimony of as many professional or amateur athletes (including three professional referees), occurred in the period between 1990 and 2024 and grouped into 10 different sport activities: Football (23), Ice Hockey (8), Basketball (6), Martial Arts (3), Professional referees (3), American Football (2), Cricket (2), Badminton (1), Volleyball (1), school physical education (1). Video analysis was made focusing on athlete’s behavior pre/during/post collapse, other athletes’ reaction, time from collapse to first aid, type of aid (and its correctness), time intervals of CPR, time intervals of AED positioning and first shock, number of AED shocks, survival and SCA causal cardiac diagnosis when possible. Results of a preliminary analysis were compared between different participants of the study for the purpose of objectifying collected data. Statistical analysis was made using Fisher X2 Test with all the variables settled and examinated for survival outcome. Results. From the analysis of 50 different video and cases (among which 29 survived and 21 deceased), it is confirmed that the majority of SCA occur during light or moderate physical activity (70%), corroborating the data from previous studies. The place in which the sudden cardiac arrest occurs appears to significantly influence the outcome (p<0.01) with a positive increase in expected survival for cases located in North America and Europe and a drastic decrease for cases located elsewhere continents. The ethnicity of the victim suffering from cardiac arrest seems to significantly influence the survival outcome (p<0,01), either positively (when “Caucasian”) or negatively (“Asian” and “Latino-American”) depending on the conditions, but this could represent an epiphenomenon of the geographic region where the sporting event was recorded especially considering that the only “non-Caucasian” subjects who survived cardiac arrest were in Europe or North America at the time of the event. Moreover, the study of pre-collapse and during collapse victim behavior, provided us results regarding athlete’s attitude right before the SCA collapse, pointing the position of the hands over the knees as related to a poor survival outcome (p<0,05). Among the additional factors determining a statistically significant difference between expected and observed outcomes are the implementation of proper emergency aid by the first responder (p<0,01) to the athlete and the timely and appropriate use of the AED (p<0,05). Conclusion. The correct implementation of cardiopulmonary resuscitation in sportive context, the identification of preliminary sign of cardiac collapse and the earlier use of an AED in case of SCA improve survival rates even in cases of athletes, whether these are amateurs or professionals.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/67190