Background There is no national reporting system for marathon sudden cardiac arrest (SCA) and death in the US.
Objective This study assessed the prevalence of SCA and death during USA marathons to assist with emergency planning at events.
Design/Setting/Participants A retrospective, web-based survey to assess details of SCA and death was sent out to 400 US marathon directors in the autumn of 2009 and summer of 2010.
Results 78/400 (19%) of marathons responded. Participants ranged from 30 to 30 000 runners with a total of 1 411 482 runners from 1976 through 2009. There were 31 SCA's including 11 deaths. The prevalence of SCA was 1 in 45 531, and 1 in 128 316 runners died. 30/31 runners with SCA were male with an average age of 46.7 years (range 19–82). Runners collapsed at the finish line (6), in the final 2 miles (6), from miles 17–23 (6), and before mile 16 (10), and three of the runner's locations were unknown. An automated external defibrillator (AED) was used in 20 cases, not used in two cases, and unknown in nine cases. The 11 non-survivors had eight non-shockable rhythms, and 11 of the 20 survivors had shockable rhythms treated with an AED. The autopsy diagnoses were coronary artery disease (8) and one runner died of congenital heart disease complications. Two causes of death were not known.
Conclusion SCA occurs in approximately 1 in 45 000 marathon runners, is more common in middle to late aged males, and can occur anywhere along the race course with the majority of cases in the final 10 miles. Prompt resuscitation including use of an AED provides a high survival rate for the victims of SCA. Emergency planning with availability of AED's throughout the race course is recommended.
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