Article Text

Download PDFPDF
Prehospital interventions and neurological outcomes in marathon-related sudden cardiac arrest using a rapid mobile automated external defibrillator system in Japan: a prospective observational study
  1. Hideharu Tanaka1,2,3,
  2. Tomoya Kinoshi1,2,3,
  3. Shota Tanaka2,4,
  4. Ryo Sagisaka2,5,
  5. Hiroyuki Takahashi1,2,3,
  6. Etsuko Sone2,
  7. Takahiro Hara3,
  8. Yui Takeda6,
  9. Hiroshi Takyu1,3
  1. 1Department of Sports Medicine, Kokushikan University, Tama, Tokyo, Japan
  2. 2Research Institute of Disaster Management and EMS, Kokushikan University, Tama, Tokyo, Japan
  3. 3Graduate School of Emergency Medical System, Kokushikan University, Tama, Tokyo, Japan
  4. 4School of Medicine, Tokai University, Isehara, Kanagawa, Japan
  5. 5Department of Integrated Science and Engineering for Sustainable Societies, Chuo University, Bunkyo-ku, Tokyo, Japan
  6. 6Department of Sports and Health Management, Jobu University, Isesaki, Gunma, Japan
  1. Correspondence to Shota Tanaka, Research Institute of Disaster Management and EMS, Kokushikan University, Tama, Tokyo, Japan; tanakamedical24{at}


Objective To describe neurological outcomes after sudden cardiac arrests (SCAs) in road and long-distance races using a rapid mobile automated external defibrillator system (RMAEDS) intervention.

Methods A total of 42 SCAs from 3 214 701 runners in 334 road and long-distance races from 1 February 2007 to 29 February 2020 were examined. Demographics, SCA interventions, EMS-related data and SCA-related outcomes were measured. Primary endpoints were favourable neurological outcomes (Cerebral Performance Categories 1–2) at 1-month and 1-year post-SCA. Secondary endpoints were factors related to the field return of spontaneous circulation (ROSC) and resuscitation characteristics, including the initial ECG waveform classification and resuscitation sequence times according to the initial ECG rhythm.

Results The SCA incidence rate was 1.31 per 100 000 runners (age: median (IQR), 51 (36.5, 58.3) years). Field ROSC and full neurological recovery at 1-month post-SCA was achieved 90.4% and 92.9% of cases, respectively. In 22 cases in which bystander cardiopulmonary resuscitation was initiated within 1 min and defibrillation performed within 3 min, full neurological recovery was achieved at 1-month and 1-year post-SCA in 95.5.% and 95.5% of cases, respectively.

Conclusions The RMAEDS successfully treated patients with SCA during road and long-distance races yielding a high survival rate and favourable neurological outcomes. These findings support rapid intervention and the proper placement of healthcare teams along the race course to initiate chest compressions within 1 min and perform defibrillation within 3 min.

  • cardiovascular diseases
  • sports medicine
  • survival
  • running
  • cardiology

Data availability statement

No data are available.

Statistics from


  • HT and ST contributed equally.

  • Contributors Conceptualisation: HTanaka. Formal analysis: RS, HTakyu. Investigation: HTanaka, TK, ST, RS, HTakahashi, ES, THara, YT. Methodology: HTanaka, TK. Project administration: HTanaka. Supervision: HTakyu. Visualisation: HTanaka, ST. Writing—Original draft: HTanaka, ST. Writing—Review and editing: HTanaka, ST. Guarantor: HTanaka.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.