Is the myth of “tongue swallowing” delaying proper cardiopulmonary resuscitation among athletes with cardiac arrest?

Background. In June 2021, during a Europa-League soccer competition, a Danish soccer player had cardiac arrest (CA). The event was witnessed by millions of spectators. The initial response of team players, attempting to prevent "tongue-swallowing," was visible on television and was inaccurately portrayed as a “life-saving measure”.

Objective. To assess the media`s role in perpetuating the misconception that tongue-swallowing should be prevented during CA.

Methods. We conducted a continuous internet search from 1990 to 2023 for videos showing athletes undergoing resuscitation maneuvers after collapsing during competition, focusing on the first response. We also analyzed the news coverage to understand how resuscitation efforts are described and their possible impact on public perception.

Results. We report 43 cases of athletes collapsing during sports that were caught on video. When the first action was visible, attempts to prevent tongue-swallowing preceded proper cardiopulmonary resuscitation (CPR) in 30 (83­%) cases. Death or severe anoxic brain damage was more likely to follow CA events when the victims were subjected to tongue-swallowing prevention maneuvers than when victims received CPR at first response [17/25 (68%) vs 0/3, p=0.041]. Twenty-six cases were covered in a total of 74 news articles. The term "tongue swallowing" appeared in 36, indicating that nearly half of the articles reinforced this misconception.

Conclusions. During bystander resuscitation of athletes with CA, attempts to prevent “tongue-swallowing are associated with increased mortality. Still, such attempts continue to be praised by social media. Education on proper CPR techniques should include a critical reassessment of the myth of tongue-swallowing.