A Structured Approach to the Collapsed Athlete: The First Minute Matters.

Abstract

The collapse of Damar Hamlin onMonday Night Football was an emotionally charged reminder to the sports medicine community of the importance of being prepared to care for the undifferentiated, collapsed athlete. In that moment, the provider must be reflexive as every decision that is made and every second it takes to make those decisions ultimately determine not only survival but also the neurological outcome of the athlete.We present an algorithm that minimizes the cognitive burden in this high stress environment while prioritizing the initial steps to optimize survival. The primary causes of death in athletes on the playing field are broadly classified into four categories: cardiac, trauma, heat, and neurological (1). Cardiac etiologies are the most common and time sensitive, so the algorithm starts by addressing the heart. Cardiac collapse in athletes is a complex condition stemming fromnumerous etiologies ranging from congenital structural or electrical abnormalities to acquired inflammatory or ischemic conditions to trauma-induced conduction alterations (1). Regardless of the precipitating cause, cardiac collapse in athletes results in a nonperfusing arrhythmia, either ventricular fibrillation or ventricular tachycardia (VF/VT) (2). The primary objectives of the sideline provider are to identify cardiac collapse and provide compressions to the nonperfusing heart until an automated external defibrillator (AED) can shock (defibrillate) the heart back to a normal, perfusing rhythm. This simplistic algorithm is time sensitive — good neurological outcome is dependent upon recognition and defibrillation within 3 to 5 min (3).