When Danish footballer Christian Eriksen collapsed on the pitch earlier this month, Nicola Vassallo's mind immediately went to the trauma her young husband had faced last September. 

The only difference was that 40-year-old Steffan was not surrounded by paramedics and doctors who could reach him in seconds.

“All he had was me!”

It took seconds for Vassallo to go unconscious and for his wife to notice something was very wrong.

“We live in an apartment, so the first thing I did was open wide the front door and scream for help.”

But she remained alone.

Then, Nicola began to administer the little CPR she knew from what her doctor father had taught her – she had never done a first-aid course – and called emergency.

But the line kept cutting off, so she called her sister, who lives close by, for assistance.

Once contacted, the paramedics stayed on the line with her, counting the seconds while she performed compressions and gave mouth-to-mouth, reaching the patient in seven minutes and taking over.

“As they left, one of them asked if I was the one to perform CPR and gave me a fist bump, telling me I had saved his life.”

Eighteen million people a year, worldwide, suffer a cardiac arrest, which means their heart suddenly stops pumping, and only 10 per cent live to tell the tale. The percentage of survival is even lower if it happens out of hospital.

“The only way to increase the survival rate is knowing how – and being ready to give – CPR within seconds. So please learn how, and if you can teach it, please do so, as it saves lives.

“My husband looked death in the eye that day, but God had other plans,” Nicola said, explaining that he had been without oxygen for 17 minutes.

“I had doctors talking about ‘if’ and ‘when’ he would wake up,” she said about the surreal experience that was “like being on the set of Grey’s Anatomy”.

Fit people have heart attacks too

Eriksen will be fitted with an implantable cardioverter-defibrillator – a mini version that shocks the heart back into rhythm should it stop again – just like Steffan.

He had spent one month in ITU, before moving on to a rehabilitation centre and is still recovering.

“People automatically think that to have a cardiac arrest, you must be unhealthy. But you cannot get any fitter than a football player,” Nicola pointed out.

Her own husband had no symptoms but was just feeling tired. He was at his fittest, playing tennis three times a week and cycling every day, but claimed he was not sleeping well.

“I would brush it off. Who was sleeping like a baby in a pandemic anyway, and with two teenagers in the house?

“We check everything, but never our hearts – one of the most important organs!”

Now, she says, she wants people to learn from her “mistake”, and apart from raising awareness, also wishes first-aid courses are introduced in the school curriculum.

This is how you can try survive a heart attack

Most people who suffer an out-of-hospital cardiac arrest do not survive because of lack of equipment and, particularly, because laypersons are not trained in basic life support and are willing to do it.

Consultant cardiologist Caroline Magri was speaking in the wake of footballer Christian Eriksen’s collapse during the Euro 2020 clash against Finland last week.

Eriksen suffered a shock cardiac arrest during Denmark’s game against Finland before being resuscitated with CPR and a defibrillator, sparking a surge in interest in life-support training, locally.

Magri maintains certain places should be better equipped with defibrillators – and the know-how to use them – listing primarily banks, churches, large supermarkets and shopping centres, which see an influx of people.

Referring to the recent death from cardiac arrest of a 43-year-old man who worked in a bank, she said: “You would assume these places, which see so many people, as well as others offering public services, would be better equipped with some form of cardiac survival kit.”

In this case, they only managed to get a pulse after 25 minutes and the patient passed away after some days in intensive therapy.

An automated external defibrillator (AED) is not hard to operate because it guides the user every step of the way, she explained, stressing they should be available in more places.

Defibrillators and how to locate them

It was not just about AEDs, but especially the lack of “actual hands on the ground”, with the knowledge and, more importantly, the willingness to do compressions, concurred Malta Resuscitation Council vice-chair Tanya Esposito.

While defibrillators were not lacking in her view, the problem was 24/7 public access to them. Although an app exists to locate a nearby defibrillator that has been registered, if it is based in an office, or a school, these close at a certain point.

While professional sports settings and events were equipped with AEDs, thanks also to St John Ambulance and Red Cross, which covered official competitions, the problem lay mostly with unfit people, who exercised on their own and exerted themselves.

“If it happens to athletes, it can happen to anyone,” said Esposito, a consultant anaesthetist, with a special interest in resuscitation, who is calling for a better spread of AEDs in better places, such as locations where people are exercising. Her “personal pipe dream” is also for a defibrillator to be a requirement in every mega apartment block.

Quoting the council’s slogan – ‘systems save lives’ – Esposito explained that the chances of someone collapsing due to cardiac arrest were far greater outside of hospital, so people needed to learn how to administer CPR because it was the first step.

The next would be the AED, so it was important there was one nearby and available.

We check everything, but never our hearts – one of the most important organs

This was followed by a quick response from 112, who would give dispatch CPR and talk the helper through, until the ambulance arrived and took over.

Bystander CPR - the weakest link

“Any system is as strong as its weakest link, which in our case is bystander CPR,” Esposito stressed.“We have a good medical team and a reasonable response time, but time is lost when people are faced with a cardiac arrest... And when the heart stops, every second means brain death.”

The council, which works on a voluntary basis to raise awareness and teach CPR to wide-ranging sectors in the medical field and the man in the street, has been inundated with requests for courses from groups, following Eriksen’s trauma.

In the process of organising a refresher course with the Malta Football Association, Esposito said the requests would be catered for, but pointed out that the CPR situation is delicate because we are still in a pandemic.

The way it was being administered had totally changed, in fact, based mostly on “very good” chest compressions.

Mouth-to-mouth training has stopped during COVID-19, but courses would soon be held to teach alternative methods of oxygenation.

While teaching programmes existed for children, they were limited, Esposito said, calling for children to have to undergo formal CPR assessment when doing their driving test to refresh their knowledge.

The European Resuscitation Council, of which the Malta branch formed part, would also like it to be part of the national curriculum, she said.