The unfortunate incidents of sudden death of young promising footballers on ground both in India and outside, shattered their dream to don their childhood favourite jersey.

As per clinical literature sudden cardiac death (SCD) or arrest (SCA) in football is primarily caused by underlying congenital cardiac abnormalities but sports itself can increase that risk. Football, having very high dynamic component, always scores in top three of highest incidence of SCA and SCD. Though commonly SCD that occurs on football ground is non contact in nature, but it can also be caused due to blunt chest trauma by opponent or football (very rare).

From 2014-2018, over a five year period, a total of 617 cases of sudden death were reported from 67 countries in FIFA sudden death registry. Majority of cases occurred at amateur level and incidence was slightly higher among defenders and midfielders. Though it is quite well established in literature that coronary artery disease (CAD) is main cause of death >35 yrs and cardiomyopathy for <35 yrs, yet there is also a high percentage of cases with normal heart at autopsy, known as sudden unexplained death (SUD).

A substantial part of all reports were received from Europe (57%) followed by South America (12%), North America (10%), Asia (8%), Africa (7%) and Australia (6%). In North America and Australia survival rates after cardiac arrest (52% and 49%, respectively) appeared more favorable than in Europe (23%) and Asia (14%).

We all know that participation in regular systematic intensive exercise is associated with structural and functional cardiac adaptations comprising the ‘athlete’s heart’. But at the same time exercise is also proven to be a trigger for SCA in individuals with underlying cardiac disorders. Hence early detection and mitigation of risk through pre participation examination (PPE) is the cornerstone. The most practical recommendation should be to initiate ECG from 14 year onwards and follow up every 1-2 year.

The initial management of this lethal condition is immediate cardio-pulmonary resuscitation (CPR) and external defibrillation (AED). The single greatest factor affecting survival from SCA is the time interval from cardiac arrest to defibrillation. Each minute of delay in initiating defibrillation after SCA leads to a 10% decrease in shock success. FIFA also introduced an exception in laws that allowed medical personnel to enter into FOP (field of play) without prior authorization of referee but with notification to fourth official in case of suspected SCA.

Irrespective of our best possible screening strategy, SCA will continue to occur on the football field. What cannot be totally prevented must therefore be managed when it does present. The medical management of SCA on the football field can only be effectively, efficiently and expeditiously managed if it is planned beforehand with a known and distributed emergency action plan.

Considering the ever increasing evidence of cardiological evaluation in sports, the same has been underexplored area in the field of sports medicine in India. Because of the outreach of print and social media we are coming across reports of sudden death on sporting field. The involvement of private stakeholders in sporting ecosystem in this country and also the effort of the Govt to reach the grassroot level by the flagship program “Khelo India”, certainly increase the professionalism in this sector.  These have acted as a boost for the children and their parents to be motivated in sports. Hence a structured cardiac evaluation program is the need of the hour in this country to avoid this kind of catastrophic event so that the athletes don’t  have to leave the field so young before reaching the goalpost.