title: Sudden cardiac arrest and death in United States marathons.
abstract: OBJECTIVE
  There is no reporting system for marathon-associated sudden cardiac arrest (SCA) or sudden cardiac death in the United States. The purpose of this study was to estimate and characterize the risk of marathon-related SCA to assist with emergency planning.
  
  
  METHODS
  A retrospective Web-based survey was sent out to all US marathon medical directors (n = 400) to gather details of SCA including demographics, resuscitation efforts, mortality, and autopsy results, if available.
  
  
  RESULTS
  A total of 88 surveys (22%) were returned from marathons run from 1976 to 2009 for a total of 1,710,052 participants. Risks of SCA and sudden cardiac death were 1 in 57,002 and 1 in 171,005, respectively. Men made up the vast majority of SCA victims (93%, mean age = 49.7 yr, range = 19-82 yr). Arrest site distributions were 0-5, 6-14, 15-22, and 23-26.2 miles. CAD was reported as the cause of death at autopsy in 7 of the 10 fatalities. An automated external defibrillator (AED) was used in 20/30 cases and associated with a higher survival (17/20 survivors vs 3/10 deaths, P = 0.0026).
  
  
  CONCLUSIONS
  SCA occurs in approximately 1 in 57,000 marathon runners, is more common in older males, and usually occurs in the last 4 miles of the racecourse. Prompt resuscitation including early use of an AED improves survival. Emergency planning to include trained medical staff and sufficient AEDs throughout the racecourse is recommended.
authors.affiliation: Crozer-Keystone Health System, Springfield, PA 19064, USA.
authors.forename: David
authors.initials: D
authors.lastname: Webner
authors.forename: Kevin M
authors.initials: KM
authors.lastname: DuPrey
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Drezner
authors.forename: Peter
authors.initials: P
authors.lastname: Cronholm
authors.forename: William O
authors.initials: WO
authors.lastname: Roberts
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data; D002423:Cause of Death; D003324:Coronary Artery Disease / Q000453:epidemiology; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D047548:Defibrillators / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012306:Risk; D012420:Running / Q000706:statistics & numerical data*; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult