Medicine for the Outdoors
Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Cardiac Arrest During Long Distance Running Races

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An article titled "Cardiac Arrest During Long Distance Running Races," written by Jonathan Kim MD and his colleagues, was published recently in the New England Journal of Medicine (2012;366:130-40). Medicine for the outdoors is not only about hiking, climbing, diving and other recreational activities in wilderness environments. It’s also about sports medicine, military medicine, expedition medicine – anywhere people pursue activities in the outdoors. We learn much from one setting that applies to another. Hence, the importance of this article.

The focus of the authors’ observations was on the incidence and outcomes of cardiac arrest associated with marathon and half-marathon races in the United States from January 1, 2010 to May 31, 2010. They noted 10.9 million runners and 59 episodes of cardiac arrest. Male marathon runners were the highest-risk group. The authors used the data to attempt to predict survival, and found that initiation of bystander-administered cardiopulmonary resuscitation (CPR) and an underlying diagnosis other than hypertrophic cardiomyopathy (a condition where the heart muscle is thickened and must work harder to pump blood) were the strongest predictors of survival.

What are the take-aways? First, if you want to be a marathon runner or (perhaps) engage in similarly prolonged, sustained, and vigorous physical activity, it’s not good to have hypertrophic cardiomyopathy. How would one know if he or she suffered from this condition? It is generally diagnosed with an echocardiogram. We’re not yet at the point where it is recommended that anyone contemplating long-distance running have a screening “echo,” but perhaps one day when medical costs are more under control, that might be feasible.

More obvious, if someone can initiate CPR upon someone immediately after a cardiac arrest, that creates a better situation than enduring a delay to CPR. Bystander CPR is unquestionably enhanced by the presence of an automated external defibrillator (AED), although that particular observation was not evaluated in this particular study. The placement of AEDs in urban settings is facilitated by the concentrations of people and their proximity to the devices. In an outdoor (particularly wilderness) setting, long distances and poor accessibility mandate carrying the device or, more commonly, doing without one.

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Tags: General Interest

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Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.

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