Cardiac Arrest During Long-Distance Running Races

Area of Science:

• Cardiology
• Sports Medicine
• Public Health

Background:

• Marathon and half-marathon participation in the US surged between 2010-2023, more than tripling compared to the previous decade.
• Contemporary data on cardiac arrest incidence and outcomes in these events were previously unknown.

Purpose of the Study:

• To determine the incidence and outcomes of cardiac arrests during US marathons and half-marathons from 2010 to 2023.
• To compare contemporary data with historical reference standards from 2000-2009.

Main Methods:

• An observational case series using the Race Associated Cardiac Event Registry.
• Cohort data from US marathon and half-marathon runners (2010-2023).
• Case profile review for etiology and survival factors, with comparisons to historical data.

Main Results:

• Among nearly 30 million finishers, 176 cardiac arrests occurred. Incidence remained stable (0.54 per 100,000 participants) compared to 2000-2009.
• Cardiac death incidence significantly declined (0.20 vs. 0.39 per 100,000), with a reduced case fatality rate (34% vs. 71%).
• Coronary artery disease was the most common cause; shorter cardiopulmonary resuscitation times and ventricular tachyarrhythmia were linked to survival.

Conclusions:

• Despite increased participation, cardiac arrest incidence in long-distance races is stable.
• A significant decrease in mortality and case fatality rates was observed.
• Effective emergency action planning, including immediate defibrillation, likely contributed to improved survival rates.