Cardiac Arrest in Young People

When we teach CPR, one of the first lessons is that adults and children need different approaches. That's because adults more often suffer cardiac arrest due to heart disease, while in young children it’s often due to breathing failure, which then causes the heart to stop. That’s why paediatric CPR training emphasises rescue breaths first.

But there’s an important exception for young people involved in sport.

Most CPR training distinguishes between adults and children for very good reason: the typical causes of cardiac arrest differ.

• Adults, mostly older adults (over 60) often go into cardiac arrest because of a heart event (e.g., heart attack).
• Children and infants, on the other hand, more commonly arrest due to breathing problems, which then lead to the heart stopping.

That’s why, in paediatric CPR, if you’re alone, you’re taught to give 5 rescue breaths first, then do 2 minutes of CPR, and then call 999 — because oxygen is likely to be the urgent need.

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Cardiac Arrest in Young People: The Important Exception Everyone Should Know

In the UK, the majority of cardiac arrests happen in adults over 60, usually related to underlying heart disease. However, young athletes under 35, though much less likely to experience cardiac arrest, can suffer it suddenly — often during or immediately after exertion.

Highlighted by the Resuscitation Council UK in their new 2025 guidelines, there is a “special circumstances” guideline for cardiac arrest in sport. They see screening as a primary prevention and give the advice: 
If someone (of any age) collapses during or just after sport and is not breathing normally → treat it as a cardiac arrest immediately.

In practice, that means, phone 999 immediately and start adult protocol CPR even if it is a child or adolescent who has collapsed. i.e. do not give 5 rescue breaths and one minute of CPR before calling 999.

One of the most high-profile incidents was when footballer Fabrice Muamba, then aged just 23, collapsed during an FA Cup match between Bolton and Tottenham in March 2012, Muamba suffered a cardiac arrest on the pitch. His heart stopped for 78 minutes, but he survived following immediate medical response.

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Why This Matters So Much: The Statistics Behind It

In the UK, it’s estimated that 12 young people aged 35 and under die every week from undiagnosed cardiac conditions and 80% of those deaths occur without prior symptoms. Charities like CRY (Cardiac Risk in the Young) work to make ECG screening more accessible. Their data suggest that about 1 in 300 young people screened (aged ~14–35) may have a life-threatening cardiac condition, many of which are manageable if detected early. [Ref: https://www.c-r-y.org.uk]

Although screening remains controversial many young people who die suddenly from cardiac causes show no prior symptoms, making screening and awareness vital. One of the most compelling pieces of evidence for screening comes from Italy.  A nationwide pre-participation cardiovascular screening program was introduced for young competitive athletes.

After screening began, the annual incidence of sudden cardiovascular death in screened athletes dropped from 3.6 per 100,000 person-years (1979–1980) to 0.4 per 100,000 person-years (2003–2004), a reduction of 89%.

Most of this drop was due to fewer deaths from cardiomyopathies, and it correlated with more athletes being disqualified from competition due to previously undetected heart disease.

[Ref: https://jamanetwork.com/journals/jama/fullarticle/203513]

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What You Can Do? As a Parent, Coach, or Club

• Encourage screening - If your young athlete is involved in organised sport, particularly competitive sport, consider cardiac screening (ECG + history + physical).
• Train people in CPR and AED use - Ensure that coaches, teachers and volunteers know how to respond to a collapse, especially assuming a cardiac cause. Make sure AEDs (defibrillators) are available at training grounds and matches
• Raise awareness among your group - Talk in club meetings, parent-coach forums, or team newsletters about the “assume cardiac arrest” principle.

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