Citizen Writes

Reports from Euro 2020 (1): Something scary in the state of Denmark

2021-06-17

Authored by John Williams, Associate Professor of Sociology
Co-authored by Professor Andre Ng, cardiologist and cardiac arrest researcher

Perspective from John Williams:

I don’t know quite how many of you, like me, were watching the Denmark versus Finland match in the Euro 2020 tournament last Saturday. You probably had better things to do. It was a fairly non-descript, rather technical and bloodless affair, as much international football is these days, especially if you have no skin in the game. No goals had been scored approaching half-time, TV fodder with little excitement for UK sports gluttons only. But then something happened which changed the whole character of the event – and the experience of watching it.

Christian Eriksen, the Danish midfielder, an elite player well known to English audiences because of the time he spent playing in the Premier League, collapsed in the top right-hand corner of the TV screen just as the ball was gently fed towards him.  All football fans recognise these symptoms.  Coaches and fans alike talk endlessly about how the ‘worst’ injuries for players often occur innocently off the ball, when muscles or tendons under no obvious strain give way, suggesting likely months out in rehab.

But the immediate response of the Danish players made it clear that something much more serious was happening here; that Eriksen had lost consciousness and required urgent – perhaps life-saving – medical attention. It is said glibly by football administrators that the ‘best’ place to have a cardiac arrest these days is in a football stadium. Stadium disasters in England and elsewhere mean equipment is readily available today to treat spectators in serious distress, and a couple of on-field incidents have produced the same response for players. It was absolutely needed right now.

The TV scenes that followed were incredibly distressing but also compulsive. As medical staff were vigorously and visibly delivering CPR to the player – a Danish official confirmed later that Eriksen had briefly ‘gone’ – his Danish playing colleagues, many in tears and distraught, formed a human shield around him to try to protect what was left of his privacy in front of tens of thousands of stadium fans and millions watching on TV.  The BBC apologised later for continuing to show these images, long after it was clear that what we were watching here, in real time, was an authentic life-or-death struggle played out on an international sporting stage.

Honestly, I am really not sure what I might have decided to do as a TV producer in the same circumstances. Nevertheless, eventually Eriksen was wheeled away out of this huddle, and a single image began to appear immediately on-line of the midfielder with eyes open, oxygen mask in place, even appearing to be brushing away hair from his face.  Relief came flooding in: it felt like a miracle had happened.

It is at times like these that TV sports presenters like to talk about how such incidents ‘put the game into perspective’ and how football is simply ‘unimportant’ compared to the family and future of a much-loved sportsman. We got that here. And yet, barely 90 minutes later the players of Denmark and Finland were back on the field to complete the match. UEFA had offered the teams the option of an immediate return, or play on lunchtime the next day, no doubt after a sleepless night. No choice at all, in fact. Set in this context the match was difficult to watch, so God knows how hard it was to play in. Unsurprisingly, Denmark lost 0-1.

The stadium chanting of both Finland and Denmark fans for the recovery of Eriksen was a welcome reminder of the shared sense of humanity among rival sports fans.  And the leadership and compassionate authority of Leicester City man Kasper Schmeichel in comforting Eriksen’s partner and his playing colleagues on the pitch from both countries was truly inspiring.  International sport can often seem petty, overly-competitive and overtly nationalistic, but at moments such as these the underlying human decency and ties that bind usually come to the fore.

Quite how long this sense of common purpose lasts is a moot point: after all, England are up and running with a win and they play Scotland on Friday evening, in a ‘noisy neighbours’ fixture not repeated on this stage since 1996. There is a lot at stake here: national pride; political agenda setting; sporting kudos and ambition.  Both sides will play it hard.  But it is nothing compared to what was briefly in the balance last Saturday evening in the Parken Stadium in Copenhagen.  The crowd there recognised as much, so a sense of proper perspective, by press, TV and fans would be welcomed this week. Sport really matters to people, of course it does, but some things actually are more important.

Perspective from Professor Andre Ng:

It was a major relief to see that effective help was available to Eriksen which averted what would otherwise have been a tragic event. CPR saves lives but there is only a narrow window of a few minutes following a cardiac arrest to be started effectively in order to sustain circulation. Ventricular fibrillation is a heart rhythm disturbance where the heart beats at over 300 beats a minute and the pump no longer functions properly, which is a frequent cause of sudden death from cardiac arrest. Defibrillation is needed promptly to shock the heart back to normal to abort death.

Whilst Eriksen is recovering from this event, questions are asked as to the how’s and why’s. The cardiologist who was looking after him during his period in Spurs had already confirmed that his previous heart tests had been normal. These would have included at least a heart tracing (electrocardiogram, ECG) and scan (echocardiogram). Italy, where Eirksen plays in Inter Milan, has one of the most advanced screening programme for athletes. It goes to show how unpredictable cardiac arrest events could be and also reflects on the fact that we do not have entirely water-proof tests to assess cardiac arrest risk.

This is an area of unmet clinical need that is the focus of my group’s research. The heart can look normal and pump normally one minute but its rhythm going into a frenzy the next moment with the pump failing.

Our group has found a specific property of the heart muscle, called restitution, to be associated with how easy it is for the heart rhythm to go wrong and translated our bench knowledge into the clinical bedside. This requires studying the electrical activity of the heart using the ECG over a range of heart beats which our data have shown to be predictive of sudden death events in patients with previous heart attacks and scar.

These are being developed into promising new markers with strong patents supported by the University of Leicester. Early data also suggest their predictive value in subjects with seemingly normal hearts and no previous cardiac history.

If these patients are identified early, they can be given the appropriate treatment, such as implanting a defibrillator (similar to a pacemaker) which can abort the lethal arrhythmia with a shock to restore normal rhythm. Our ongoing work is supported by grant funding from the British Heart Foundation, Heart Research UK and Medical Research Council.

Tags: Sport

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