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The standard life-saving steps taught in first aid are clear: if someone collapses, check their airways, breathing, and circulation before starting chest compressions if needed. But experts now warn that this approach to CPR may actually increase the risk of death for athletes suffering cardiac arrest.
Researchers in Israel say focusing on clearing airways—especially the mistaken belief that someone can “swallow their tongue”—delays crucial CPR in these cases.
“The first response should be immediate chest compressions,” said Dr. Dana Viskin from Tel Aviv University. She explained that the tongue is anchored in place by muscles and ligaments, making it impossible to swallow. However, severe tongue muscle relaxation could block the airway and cause suffocation.
Viskin stressed that prioritizing airway checks in athletes experiencing cardiac arrest is dangerous. “Quick action—especially chest compressions and early defibrillation—is critical. Wasting time checking airways or trying to stop ‘tongue swallowing’ only delays life-saving treatment,” she said.
In a study published in the Canadian Journal of Cardiology, Viskin and her team reviewed 45 online videos of athletes collapsing during competitions or training between 1990 and 2024. In 38 cases, the first responder’s actions were visible.
Of the 30 athletes who suffered cardiac arrest, 27 received “inappropriate” first responses—such as forcing the mouth open to prevent “tongue swallowing”—before CPR began. This happened when Denmark’s Christian Eriksen collapsed during a Euro 2020 match in 2021.
In 18 of those 27 cases, the athlete later died or remained in a vegetative state. None of the three athletes who received immediate CPR faced such outcomes.
“The small number of cases where CPR was started right away limits strong statistical comparisons on outcomes like brain injury,” Viskin said. “But the consistent pattern of incorrect first responses in most cases is striking—and that alone is a significant finding.”
The researchers also analyzed news coverage of these incidents, finding many reports used the term “tongue swallowing” and praised efforts to prevent it. “This matters because these articles reach huge audiences,” the authors noted.
The team suggested the myth of tongue swallowing is widespread and may have been unintentionally reinforced by the traditional A-B-C (airway, breathing, circulation) CPR sequence. In 2010, the American Heart Association updated its guidelines to prioritize chest compressions (C-A-B).
A spokesperson for the College of Paramedics said bystanders witnessing a suspected cardiac arrest should follow UK Resuscitation Council guidelines: start chest compressions and call 999 if someone is unconscious, unresponsive, and not breathing normally.
“Early chest compressions are vital in saving lives during cardiac arrest, which is why paramedics don’t delay them,” they said. “When trained responders are present, one professional will focus on compressions while another manages the airway.”
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