Sudden cardiac death in an Italian competitive athlete: Pre-participation screening and cardiovascular emergency care are both essential

We here report on a sudden cardiac death during athletic competition in Italy, a country where annual pre-participation screening for sport activity is mandatory by law and proven to be life-saving. The case offers an opportunity to discuss current limitations of primary prevention through the early identification of patients at risk, and the persisting need of implementing secondary prevention measures by a proper treatment of cardiac arrest in sport arenas. A top-level football athlete, with regular annual pre-participation screening according to the Italian law, died suddenly during a football match of the Italian premier league. At 29′42′′ of the first half-time of the football match, while running in the football course, he fell down a first time on his knees, tried to get-up, and, after 5 s, collapsed again in a prone position. After 12 s, the team physician promptly intervened and found him unresponsive and unconscious. After 27 s a Red-Cross volunteer brought a semi-automated external defibrillator (sAED) to the resuscitation scene.While external cardiacmassagewas performed, the sAEDwasnever used. At 2′47′′ the athletewas put on a stretcher and rapidly transferred to an ambulance to the emergency room of the nearby hospital, where he arrived, with ongoing uninterrupted cardiopulmonary resuscitation (CPR) manoeuvres, 10 min after onset of the cardiac arrest. At the arrival, the ECG monitor documented ventricular fibrillation (VF). Despite multiple DC shocks, the athlete died.