Key result
Bystander CPR and AED use linked to ~32% survival to discharge after exercise-related SCA.
Why the study?
To evaluate the provision of bystander interventions and rates of survival after exercise-related sudden cardiac arrest.
Are bystander CPR and AED use associated with improved survival after exercise-related sudden cardiac arrest?
Systematic Review
Are bystander CPR and AED use associated with improved survival after exercise-related sudden cardiac arrest?
Bystander CPR and AED use are associated with improved survival in exercise-related sudden cardiac arrest, highlighting the critical importance of early recognition and rapid access to defibrillation.
Supports prioritizing bystander CPR/AED training at exercise sites; extends resuscitation evidence to exercise-related arrests.
OBJECTIVE: To evaluate the provision of bystander interventions and rates of survival after exercise-related sudden cardiac arrest (SCA). DESIGN: Systematic review. DATA SOURCES: MEDLINE, EMBASE, PubMed, CINAHL, SPORTDiscus, Cochrane Library and grey literature sources were searched from inception to November/December 2020. STUDY ELIGIBILITY CRITERIA: Observational studies assessing a population of exercise-related SCA (out-of-hospital cardiac arrests that occurred during exercise or within 1 hour of cessation of activity), where bystander cardiopulmonary resuscitation (CPR) and/or automated external defibrillator (AED) use were reported, and survival outcomes were ascertained. METHODS: Among all included studies, the median (IQR) proportions of bystander CPR and bystander AED use, as well as median (IQR) rate of survival to hospital discharge, were calculated. RESULTS: A total of 29 studies were included in this review, with a median study duration of 78.7 months and a median sample size of 91. Most exercise-related SCA patients were male (median: 92%, IQR: 86%-96%), middle-aged (median: 51, IQR: 39-56 years), and presented with a shockable arrest rhythm (median: 78%, IQR: 62%-86%). Bystander CPR was initiated in a median of 71% (IQR: 59%-87%) of arrests, whereas bystander AED use occurred in a median of 31% (IQR: 19%-42%) of arrests. Among the 19 studies that reported survival to hospital discharge, the median rate of survival was 32% (IQR: 24%-49%). Studies which evaluated the relationship between bystander interventions and survival outcomes reported that both bystander CPR and AED use were associated with survival after exercise-related SCA. CONCLUSION: Exercise-related SCA occurs predominantly in males and presents with a shockable ventricular arrhythmia in most cases, emphasising the importance of rapid access to defibrillation. Further efforts are needed to promote early recognition and a rapid bystander response to exercise-related SCA.
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Grubic et al. (2021) conducted a systematic review in Exercise-related sudden cardiac arrest (SCA). Bystander CPR and automated external defibrillator (AED) use was evaluated on Survival to hospital discharge. Bystander CPR and AED use were associated with survival after exercise-related sudden cardiac arrest, which had a median survival to hospital discharge rate of 32%.
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