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Sudden Cardiac Arrest and Death in United States Marathons


Medicine & Science in Sports & Exercise: October 2012 - Volume 44 - Issue 10 - p 1843–1845
doi: 10.1249/MSS.0b013e318258b59a
Clinical Sciences

Purpose 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.

1Crozer-Keystone Health System, Springfield, PA; 2School of Medicine, University of Washington, Seattle, WA; 3Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and 4Medical School, University of Minnesota, Minnesota, Minneapolis, MN

Address for correspondence: Kevin M. DuPrey, D.O.,Crozer-Keystone Health System, 1260 East Woodland Ave., Springfield, PA 19064; E-mail:

Submitted for publication February 2012.

Accepted for publication April 2012.

©2012The American College of Sports Medicine