Key result
Exercise-related cardiac arrests at sports arenas are linked to ~185% higher survival odds versus outside arenas.
Why the study?
The chance of surviving exercise-related out-of-hospital cardiac arrest (OHCA) may differ by location, with a hypothesis that sports arenas have better prognosis due to increased bystander CPR and AED availability.
Does occurring at a sports arena improve 30-day survival in exercise-related out-of-hospital cardiac arrest?
Observational (n=268)
Yes
Does occurring at a sports arena improve 30-day survival in exercise-related out-of-hospital cardiac arrest?
Odds Ratio: 2.85 (95% CI 1.64–5.02)
Absolute Event Rate: 55.7% vs 30%
p-value: p=0.0002
Exercise-related out-of-hospital cardiac arrests occurring at sports arenas have a significantly higher 30-day survival rate compared to those occurring outside arenas, likely due to higher rates of bystander CPR and public AED use.
May support prioritizing AEDs at sports arenas; leaves open causal mechanisms and generalizability in exercise-related OHCA.
BACKGROUND: The chance of surviving an out-of-hospital cardiac arrest (OHCA) seems to be increased if the cardiac arrests occurs in relation to exercise. Hypothetically, an exercise-related OHCA at a sports arena would have an even better prognosis, because of an increased likelihood of bystander cardiopulmonary resuscitation (CPR) and higher availability of automated external defibrillators (AEDs). The purpose of the study was to compare survival rates between exercise-related OHCA at sports arenas versus outside of sports arenas. METHODS: Data from all treated exercise-related OHCA outside home reported to the Swedish Register of Cardiopulmonary Resuscitation (SRCR) from 2011 to 2014 in 10 counties of Sweden was analyzed (population 6 million). The registry has in those counties a coverage of almost 100% of all OHCAs. RESULTS: 3714 cases of OHCA outside of home were found. Amongst them, 268(7%) were exercise-related and 164 (61.2%) of those occurred at sports arenas. The 30-day survival rate was higher for exercise-related OHCA at sports arenas compared to outside (55.7% vs 30.0%, p<0.0001). OHCA-victims at sports arenas were younger (mean age±SD 57.6±16.3 years compared to 60.9±17.0 years, p = 0.05), less likely female (4.3% vs 12.2%, p = 0.02) and had a higher frequency of shockable rhythm (73.0% vs 54.3%, p = 0.004). OHCAs at arenas were more often witnessed (83.9% vs 68.9%, p = 0.007), received bystander CPR to a higher extent (90.0% vs 56.8%, p<0.0001) and the AED-use before EMS-arrival was also higher in this group (29.8% vs 11.1%, p = 0.009). CONCLUSION: The prognosis is markedly better for exercise-related OHCA occurring at sports arenas compared to outside. Victims of exercise-related OHCA at sports arenas are more likely to receive bystander CPR and to be connected to a public AED. These findings support an increased use of public AEDs and implementation of Medical Action Plans (MAP), to possibly increase survival of exercise-related OHCA even further.
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Torell et al. (2019) conducted an observational in Exercise-related out-of-hospital cardiac arrest (n=268). Occurrence at a sports arena vs. Occurrence outside of a sports arena was evaluated on 30-day survival (OR 2.85, 95% CI 1.64-5.02, p=0.0002). Exercise-related out-of-hospital cardiac arrests occurring at sports arenas were associated with a significantly higher 30-day survival rate compared to those occurring outside of arenas (55.7% vs 30.0%, age-adjusted OR 2.85).
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