Marathon collapses need help
Posted 4/19/2012
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A marathon runner had just passed mile 25 on the Boston Marathon route when he staggered and collapsed. His 34-year-old son and running companion - along with a police officer and another runner - carried the barely-responsive marathoner to the roadside.
A physician spectator jumped the barrier and performed cardiopulmonary resuscitation minutes before a Boston EMT used an automated external defibrillator (AED) on the then-63-year-old marathoner. He was taken to Beth Israel Deaconess Medical Center, where he became responsive en route to the hospital and was released three days later.
This survival story in 2010 is one of three cardiac arrest collapses on the Boston Marathon route since its debut 115 years ago. The other two men, in 1973 and 1996, were not so fortunate and passed away.
The differences between this man's survival and the two previous fatalities are timing and technology. The likelihood of survival decreases by 10 percent for each minute of delay from collapse to CPR to defibrillation, according to a February 2012 article in Pacing and Clinical Electrophysiology (PACE), co-written by retired BIDMC cardiologist Stafford I. Cohen, MD, and Ethan R. Ellis, MD, Cardiology Fellow.
"A person's best chance for survival, if he or she collapses on the marathon route, is to be given immediate CPR and prompt AED," said Cohen. "CPR can extend the time until AED is used. Timing is crucial because your brain needs oxygen."
Instances of cardiac arrest on the course are rare, and most cases are caused by underlying cardiac problems, such as the 1996 victim who had a suggestive history of coronary artery disease and took 5 ½ hours to reach the finish line, where he collapsed.
"The likely profile of a runner at risk for cardiac arrest during a marathon is a history of coronary artery disease, older age and being on the course for more than four hours," Cohen and Ellis wrote. The age of 35 separates older from younger runners. Men are more prone to cardiac arrest during physical exertion, but the reasons are not perfectly clear, according to Cohen.
"Marathons are grueling and involve hard cardiac work," said Cohen. "It is a stressor for preexisting heart conditions."
This does not mean that running a marathon should be avoided, but rather runners should thoroughly and properly train for it. "The Boston Marathon is a qualifying race for the Olympics," said Cohen. "It's understood that training for a marathon is healthy. If you're not healthy and haven't had your physician's approval to run a marathon, you shouldn't enter."
Despite the risk factors, the odds of suffering cardiac arrest on the course are low, with a range as high as one in 200,000. The survival in 2010 was Boston's first, "a statistic to be added to the growing number of fortunate runners whose lives have been restored with chest compression and an AED while on the pavement of a marathon," Cohen and Ellis wrote.
This year, the American Red Cross is offering CPR training to runners, their friends and family members so lifesaving efforts can begin sooner. Community police vehicles and ambulances are also equipped with AEDs, and runners' medical needs are assessed upon their completion of the marathon. Those with problems are triaged to medical tents with advanced lifesaving capabilities, set up just beyond the finish line. On race day, approximately 60 AEDs are also placed along the route.
"Organizers have to be prepared," said Cohen. "They never know what will happen."
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