The Unlikely Story of Anesthesiologists in Professional Sports

By Arjun Mathur

On the evening of Monday, January 2, 2023, NFL safety Damar Hamlin of the Buffalo Bills suffered a cardiac arrest while playing against the Cincinnati Bengals in Cincinnati, Ohio. Hamlin went into cardiac arrest and immediate resuscitative measures were started including CPR and defibrillation to maintain perfusion to his brain, heart, and kidneys. (1) Hamlin was then stabilized and intubated while he was being taken to the University of Cincinnati Medical Center. The physician in charge of Hamlin’s intubation was a designated NFL airway physician, a physician on the sidelines of every NFL game who can perform intubations in critical situations such as cervical spine injuries and cardiac arrests. These physicians are usually anesthesiologists or emergency medicine doctors who can perform rapid sequence intubations and worst-case scenario, cricothyrotomies in players during emergencies. The NFL started designating mandatory airway management physicians on the sideline 12 years ago, with each team employing their own airway management physicians.

Before there was Damar Hamlin, another NFL incident back in 2005 led to a group of anesthesiologists to be contracted by the San Francisco 49ers to be on the sideline of every game as designated airway physicians during the 2005 season. I had the opportunity to chat with Dr. Richard Novak, an anesthesiologist who was a part of the Stanford Medical Team of doctors called into duty. He told me the story of Thomas Herrion, a backup offensive lineman who collapsed postgame after playing just 20 snaps. He unfortunately ended up passing away and his autopsy reports indicated severe blockage of his RCA and he his cause of death was presumably from acute coronary syndrome and cardiac arrest. This tragic event first opened the door for the idea of designated airway physicians in American professional sports.

Dr. Novak said that back then when he had the opportunity to step on the field as the emergency airway physician for the 49ers, he only had a regular laryngoscope, ET tube and stylette, and a bag with propofol, rocuronium, and succinylcholine to be administered intramuscularly albeit at much larger doses in case an emergency should arise. Now, Novak says, he’d probably recommend that the entire operation include multiple people, particularly someone who can put an IV in in difficult situations, as well as some fluids and a crash cart with a video laryngoscope, a sedative, and a paralytic. Dr. Novak reminded me that regardless of your setting, whether it’s the ICU, ER, or the football field, the most important things to remember when seeing a patient who may need an RSI, no matter how big they are, are the basics: airway, breathing, and circulation.

As for whether other sports where cervical spine injuries and potential cardiac arrests should implement emergency airway physicians, Dr. Novak said while it was not a bad idea, the sheer mass of NFL athletes and the power and speed they play with creates a force which is hard to recreate in other sports. Still, there are examples of athletes having sudden cardiac arrests which could make emergency airway physicians necessary for other sports. One example which comes to mind relevant to the United States in the next year is when Christian Erikson, a Danish soccer player, suffered a cardiac arrest on the field during the Euro 2020 tournament. While FIFA has an Emergency Action Plan outlining the protocols for sudden cardiac arrests and cervical spine injuries, it will be interesting to see if FIFA follows the NFL’s lead and designates an airway physician for each World Cup game next year (2).
  
As the sporting world continues to evolve, the medical needs for athletes should as well. Having physicians with expertise in critical care can be the difference between life and death when emergencies like Damar Hamlin and Thomas Herrion arise on and off the field of play. Hopefully, my fellow colleagues and I can continue to hone our skills so that one day it can be us on the sidelines, practicing those same basic tenets: airway, breathing, and circulation.

References

Defibtech, LLC. (2023, January 11). How the chain of survival resulted in a positive outcome for Damar Hamlin. https://www.defibtech.com/news/latest/damar-hamlin-chain-of-survival/

Patterson M, Gordon J, Boyce SH, Lindsay S, Seow D, Serner A, Thomson K, Jones G, Massey A. Set-piece approach for medical teams managing emergencies in sport: introducing the FIFA Poster for Emergency Action Planning (PEAP). Br J Sports Med. 2022 Jul;56(13):715-717. doi: 10.1136/bjsports-2021-105126. Epub 2022 Feb 14. PMID: 35165085; PMCID: PMC9209678.