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Bowing, kneeling and ‘prostration’: athlete's collapse patterns during sudden cardiac arrhythmia/arrest on the field of play


Background Sudden cardiac arrest (SCA) on the field of play remains one of the most tragic and challenging events for a team physician. Even with robust regular preparticipation cardiac screening we cannot prevent all cases of SCA. Ability to recognise imminent cardiac arrest occurring on the field of play remains an important step in managing this condition without delay.

Methods You Tube was searched for video clips clearly depicting the sequence of an athlete's collapse of cardiac origin. A pattern of collapse was subsequently analysed.

Results 13 cases were available for public viewing on You Tube and demonstrated the final position of collapse. 12 collapses had full video footage of athlete's fall. All athletes were men. 84.6% (11) cases were from football (soccer). 15.4% (2) of cases were from martial arts. In 10 out of 12 cardiac event cases (83.3%) bowing and/or kneeling were followed by decubitus position. 58.3% (7) of cases demonstrated bowing at the beginning of collapse. 58.3% (7) cases had kneeling as an element of collapse. 61.5% (8 out of 13 cases) of casualties adopted position of ‘prostration’ (ie, prone) as final stage of collapse.

Conclusions When on the field of play, in the absence of head injury, athletes displaying bowing and/or kneeling positions followed by collapse should be assumed to have a life-threatening cardiac event. Final position of ‘prostration’ was adopted in over half of cardiogenic collapses. A sports medicine professional should bear this in mind and target his/her assessment and treatment accordingly. When attending such casualties, a defibrillator must be taken to the collapsed player.

  • arrythmia
  • cardiac arrest
  • death/mortality
  • doctors in PHC
  • prehospital care, doctors in PHC

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