Sudden Cardiac Death in Young Athletes: Screening and AEDs

Those of you who follow football (or what we with American 'exceptionalism' call 'soccer') will be familiar with the tragic story of the Italian footballer Pieromario Morosini  who collapsed and died over the weekend.  A similar story with a happier, almost miraculous, ending occurred last month when Fabrice Muamba of the Bolton Wanderers collapsed on the pitch when playing against Tottenham Hotspurs.  He survived.

In both cases, Automatic External Defibrillators (AEDs) were used, though I understand there was a several minute delay in Morosini's case. AEDs are a wonderful technology, and can be invaluable in these cases of "cardiac arrest" (which is less a medical diagnosis than a layperson's description for what were probably events known as "ventricular tachycardia" or "ventricular fibrillation").  They are extraordinarily easy to use: it has been demonstrated that sixth graders can employ the devices as readily as trained paramedics.

I have had the dubious privilege of using an AED on a plane once, on an elderly woman who had collapsed.  The stewardesses summoned a doctor on the plane, and I responded.  And thank God, there was an AED.  The device brought the patient back.  I was so grateful. And I can vouch for the fact that they are very easy to use, even under the most stressful of circumstances.

There is great controversy over the question of screening for cardiac abnormalities, whether the population is professional football players or young recreational athletes.  Ironically, some of the most impressive work in this area has come from the Italian research group headed by Domenico Corrado.  I've also greatly enjoyed the work of Jonathan Drezner in this area, and I plan in an upcoming blog post to talk about this issue and some of Dr. Drezner's work in particular. This type of screening is called "secondary prevention" in medicine, and amounts to a type of Preventive Medicine which is designed to catch a disease in its early stages, before serious outcomes (such as death) can occur.  In other words, do we have a test that could identify athletes such as these two football players before they collapse?  The answer is 'yes,' but with some big qualifiers.

Screening with an electrocardiogram (EKG) or an echocardiogram can be done, and may have found underlying diseases in Morosini or Muamba which could have indicated they were at risk for death or near-death events.  There are problems with such screening, however, and that is what I intend to discuss in the near future.

For now, I am filled with sadness for the family of Morosini, and for Muamba, whose career is very likely over.  The words of A.E. Housman, from his poem To an Athlete Dying Young come to mind:

Today, the road all runners come,
Shoulder high we bring you home,
And set you at your threshold down,
Townsman of a stiller town.


Let's say a prayer for Pieromario Morosini and his family, who has left us; and a prayer for the continued
recovery of Fabrice Muamba.