Sudden Cardiac Arrest and Death in United States Marathons


Medicine & Science in Sports & Exercise:
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.

Author Information

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