Analysis of Sudden Cardiac Arrest during Marathon Races in Japan

Objective: Increased number of runners in Japan has been one reason for increasing the risk of cardiac arrest during marathon races. The purpose of the study was to examine 1) the incidence of cardiac arrest during marathon races held in the past in Japan, 2) the characteristics of runners with cardiac arrest, 3) the effectiveness of public access defibrillation (PAD) use for cardiac arrest cases. Methods: We examined the incidence of the cardiac arrest during marathon races in Japan from the medical records of marathon races that Kokushikan University provided in the past five years. Also, we analyzed cardiac arrests occurred in Japan in the past 15 years between 1999 and 2013. Results: The incidence rate of cardiac arrest was 2.18 per 100,000 participants. As shown in Table 1, the incidence rates were 2.00 per 100,000 participants in full marathon and 2.50 per 100,000 participants in half-marathon. A total of 63 cardiac arrests occurred in the past 15 years, and the number of incidents has been increasing every year. Among 63 cardiac arrest cases, the mean age was 45.3 ± 14.9 years old and 93.7% (59/63 cases) were in males. Eighty-three percentage of cardiac arrest cases applied AED (20/24 cases) were the shockable rhythm. In terms of the survival rate, there was a statistically significant difference between the cases where both bystander CPR and PAD were delivered and the cases where the only bystander CPR took place without PAD (95.0% vs. 47.1%; p < 0.05). In Japan, the case of the PAD use during marathon races has been increasing since the use of AED was permitted for public citizens in 2004. Conclusions: Performing PAD on the scene during marathon races could be expected to be higher in the survival rate. Creating a medical support system is needed to handle sudden cardiac arrest rapidly in order to perform early bystander CPR and PAD.