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Letters Field of play resuscitation

Do not move player requiring resuscitation on field until return of spontaneous circulation

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e2448 (Published 02 April 2012) Cite this as: BMJ 2012;344:e2448

Rapid Response:

Re: Do not move player requiring resuscitation on field until return of spontaneous circulation

Whilst we support Lyon and Wiggins’ evidence based approach to field of play resuscitation we also believe that each situation must be judged on its merits. Each situation is completely different and the recent case, if anything, highlights this view. An OOH arrest with no bystander CPR is a completely different situation compared with an event where several team doctors and a consultant cardiologist are present. Would the patient have been in a better clinical state for 78 minutes of un-interrupted CPR on the White Hart Lane pitch rather than CPR before and during immediate transfer to the expertly staffed and equipped cardiac intensive care unit?(1)

We must be realistic; there will unfortunately always be breaks in totally effective CPR, even without transferring the patient; during shocks and during CPR giver transfers for example. Surely the key here is to minimise the frequency and length of breaks in effective CPR, whilst getting the patient to an appropriate area of higher care as soon as possible. The alternative is bringing the intensive care unit to the patient, which with London’s Helicopter Emergency Medical Service (HEMS), may have been a real possibility. Even with this remarkable service, we believe that it would be impossible to fully investigate and correct an electrolyte disturbance or toxicity pitch side, (two of the reversible causes of cardiac arrest).(2)

(1)Roan, Dan. Fabrice Muamba was 'dead' for 78 minutes - Bolton doctor [Internet]. 2012 [updated 2012 March 25; cited 2012 Apr 06]. Available from: http://www.bbc.co.uk/sport/0/football/17460781
(2)United Kingdom. Resuscitation Council. Adult Advanced Life Support. Resuscitation Guidelines. London: 2010

Competing interests: No competing interests

07 April 2012
Alexander L Jones
F1 Doctor in Cardiology
Alexandra Moorhouse (4th Year Medical Student, Barts and The London SMD)
Bristol Heart Institute, Bristol Royal Infirmary
Ward 53, Bristol Heart Institute