Highlights: 20 years ago, on June 26, 2003, footballer Marc-Vivien Foé died on the pitch, struck down by a heart attack. After the death of the Cameroonian and other tragedies, radical changes have taken place. UEFA regulations strengthened medical examinations of players and introduced new rules, including the mandatory presence of an ambulance equipped with a defibrillator at each match. "There is a move upmarket in care, care and rescue," former international referee Bruno Derrien tells RFI.

20 years ago, on June 26, 2003, footballer Marc-Vivien Foé died on the pitch, struck down by a heart attack. After the death of the Cameroonian and other tragedies, radical changes have taken place...

Footballers' health: what Marc-Vivien Foé's death changed

The very rapid intervention of the emergency services made it possible to bring back to life the Danish footballer Christian Eriksen, victim of a cardiac arrest on June 12, 2021 against Finland during Euro 2020. AP - Wolfgang Rattay

Text by: Nicolas Bamba Follow

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Some images are indelible. Those seen in Lyon, on June 26, 2003, are unfortunately part of it. In this Gerland stadium that he knew so well, Marc-Vivien Foé left suddenly. During the semi-final of the Confederations Cup against Colombia, the Cameroonian colossus collapsed and never got up. He was only 28 years old.

This vision of the inanimate footballer, his eyes revulsed in the center of the field, traumatized the football planet and beyond. On that day, the Indomitable Lion succumbed to a heart attack. Later, the autopsy revealed that he was suffering from hypertrophic cardiomyopathy, or more simply an increase in the size of the heart.

The syndrome of sudden death of the athlete due to cardiac arrest during physical exertion was already known, and Marc-Vivien Foé was not the first high-level footballer to be a victim. But this filmed drama, followed by another highly publicized shortly after – the Hungarian Miklos Fehér, who died at the age of 24 during a Benfica match against Guimaraes in Portugal, on January 24, 2004 – highlighted this risk and the need to step up prevention work around heart problems.

« There was an awareness after Foé's death »

Football authorities began taking action shortly after the deaths of Foé and Fehér. As early as Euro 2004, UEFA regulations strengthened medical examinations of players and introduced new rules, including the mandatory presence of an ambulance equipped with a defibrillator at each match. Because the death of Foé had highlighted shortcomings in this area.

The Cameroonian had remained alone for a few moments, lying on the ground, before the actors of the meeting realized the gravity of the situation. The intervention of the emergency services was chaotic: no cardiac massage was performed on the field and it took nearly three minutes for the player to be evacuated awkwardly on a stretcher. Efforts to revive him backstage were in vain.

A statue depicting Marc-Vivien Foé on the premises of his abandoned football academy in Yaoundé, February 2, 2022. AP - Sunday Alamba

Awareness of these risks is also, since the tragedy, very different. As early as 2004, in France, the Professional Football League (LFP) required professional clubs to monitor the biological and cardiological monitoring of players. The regulation stipulates that professional footballers must undergo, among other things, two biological examinations per year, a resting electrocardiogram and a cardiac ultrasound.

In addition, from 2006, the LFP required each club to equip itself with a defibrillator. "There is a move upmarket in care, care and rescue. And that's good," former international referee Bruno Derrien told RFI.

Doctor at CS Sedan-Ardennes from 2003 to 2013, Manuel Afonso explains for his part that "there was an awareness after the death of Marc-Vivien Foé, especially in terms of tests carried out with players". "These were much more advanced afterwards, with longitudinal follow-up, cardio tests before each start of the season ... We were much more attentive," he confirms.

Marco Randriana and Christian Eriksen, two memorable miracles

The effects of this preventive reinforcement could be observed quickly. On 18 January 2008, during a Ligue 2 match between Sedan and Niort, a Chamois Niortais player, Marco Randriana, suffered a cardiac arrest. The rescuers, namely Manuel Afonso and the rest of the medical team mobilized for this match, did not hesitate for a moment. "I rushed," recalls the one who officiates today in the Senegal team.

The intervention was life-saving. With the help of the defibrillator that the Sedan club had been equipped with for years already, Marco Randriana's heart went back and the player was brought back to life. In such cases, the speed of care is crucial. For Bruno Derrien, who held the whistle from 1991 to 2007, the authorization of the refereeing body to enter the field – as is usually the case – is of course dispensable: "The medical staff does not have to wait. He comes in right away, it's normal. The main thing is not the game but the health of the player.

During a cardiac arrest, blood is no longer propelled to the organs, including the brain. The shorter the stop, the less damage there will be. This is why it is imperative to react as quickly and appropriately as possible," says Manuel Afonso, a proponent of learning life-saving gestures at school. "The sooner you intervene, the higher the person's chances of survival," he continues.

A message from @ChrisEriksen8.
♥️🤍 pic.twitter.com/WDTHjqE94w

— DBU - En del af noget Større (@DBUfodbold) June 15, 2021

An even more recent illustration is what happened to Christian Eriksen on June 12, 2021, during a Euro match between Denmark and Finland. The attacking midfielder collapsed, suffering a cardiac arrest. Referee Anthony Taylor and the players alerted emergency services just four seconds after he fell. Simon Kjaer, the Danish captain, immediately put his teammate in a lateral safety position and began the cardiopulmonary resuscitation procedure. And less than 25 seconds after falling unresponsive, Eriksen was taken care of by the medical team, who would restart his heart moments of anguish later.

The rescuers on the ground were very professional, very operational " says Manuel Afonso, who insists as much on medical procedures as on "how to protect Eriksen from everyone's view". The Danish players took care to surround their teammate on the ground during the operation and before the doctors deployed sheets to work serenely.

« Hazards that cannot be prevented »

However, the protocols in force over the past 20 years are not guaranteed infallibility. "These kinds of events remain of the order of the total unpredictable. We may have equipment, but you never know how it's going to go," says Manuel Afonso. On 25 August 2007, Spaniard Antonio Puerta, during a match between his club, Sevilla, and Getafe, was resuscitated on the pitch after a cardiac arrest. But his heart gave out again several times after his evacuation from the field, and the player died three days later in hospital.

The medical follow-up of the players does not rule out all the risks either. If the tests have detected potentially dangerous anomalies – Lilian Thuram during his abortive transfer to PSG in 2008 for example – the unexpected requires constant vigilance. "Despite all the efforts in terms of screening and prevention, there are hazards that cannot be prevented. Look at Christian Eriksen, who is not Mr. Everyman," notes Manuel Afonso. The Dane played at the time with Inter Milan and now plays for Manchester United, the English championship tolerating footballers with an implantable defibrillator.

According to the French Federation of Cardiology, each year, more than 500 athletes die of cardiac arrest in the middle of physical exertion.

Reacting to a person in cardiac arrest

In the presence of a person – athletic or not – victim of a cardiac arrest, she recommends three successive reflexes to have.

1) Alert the emergency services

2) Practice a cardiac massage

3) Use an automated external defibrillator (AED) if one is nearby

The Staying Alive app, created in 2011, can be very useful to you. It lists AEDs close to your geographical location. She also gives advice about life-saving gestures, and if you are trained in these gestures, you can be a "Good Samaritan": so if someone asks for help in the Staying Alive app and you are nearby, you can join them and help save a life.

Footballers' health: what Marc-Vivien Foé's death changed

Footballers' health: what Marc-Vivien Foé's death changed

« There was an awareness after Foé's death »

Marco Randriana and Christian Eriksen, two memorable miracles

« Hazards that cannot be prevented »

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