Sudden cardiac arrest during sports.

Exercise can trigger an acute cardiac event which may precipitate sudden cardiac arrest (SCA). On the other hand, exercise is important for physical fitness and prevention of cardiovascular disease, and the medical community should therefore inform the general public of the health benefits of sports and exercise. At the same time, the public are exposed to alarmist mass media coverage of athletes or ordinary people collapsing during different sport activities, raising uncertainties, questions, and debate within communities. The worst possible consequence would be that the public abstain from physical exercise. It is therefore of utmost importance to document the current reality of sports-related SCA. In two studies from France and The Netherlands, the incidence and prognosis of exercise-related out-of-hospital cardiac arrest (OHCA) have now been reported. Different epidemiological characteristics and factors associated with improved survival were explored, analysed, and investigated. In a 5-year community-based French registry assessing the incidence and outcome of SCA during sports in subjects of 10–75 years old, Marijon and co-workers recorded 820 SCAs, with a mean age of 46 years and a 20:1 predominance of male victims. Half of the SCAs occurred in typical sports facilities. Their major finding was huge regional disparities related to survival. The overall survival at hospital discharge was 16%, varying from 3% in the worst regions up to 44% in the best regions. As in OHCA in general, bystander cardiopulmonary resuscitation (CPR) was a main contributor to the survival differences, with overall frequency 31%; only 15% in the regions with the worst survival and up to 81% in the regions with the best survival. As a consequence, a higher rate of initial shockable rhythm (79%) was present in the regions with good outcome compared with only 29% in regions with low survival. Importantly, regions with the best survival had documented well-organized programmes for educating lay people in Basic Life Support (BLS), as well as a long and positive experience with community programmes for the use of automated external defibrillators (AEDs). Berdowski et al. documented data for all OHCAs of cardiac origin in persons aged 10–90 years over a 3-year period in the Dutch province North Holland, and found that 143 (6%) arrests were exercise related. They compared outcome in these exercise-related OHCAs with that of the non-exercise-related arrests, as well as outcome amongdifferent agegroups. Exercise-relatedarrestshada significantly higher survival rate than non-exercise related OHCAs in victims .35 years old (46% vs. 17%, respectively, P , 0.001), but not for victims ,35 years old (14% vs. 18%, respectively, P 1⁄4 0.82). No firm conclusion can be drawn for the latter, however, as the numbers are too small, with only seven exercise-related arrests among victims aged ,35 years. Amongthe143exercise-relatedOHCAs, themeanagewas59years, and 93%weremen. The exercise-relatedarrests were more likely tooccur in public places, were more frequently witnessed, had higher rates of bystander CPR, and a shockable initial rhythm, as well as higher use of AEDs and shorter Emergency Medical Services (EMS) response times. These are all known factors associated with better outcome after OHCA, but, afteradjusting for thesevariables in themultivariate analysis, exercise-related OHCA was still associated with better outcome, even with good neurological outcome. These two papers from western European countries have two important messages that need to be highlighted. First, they both show thatsports-relatedcardiacarrestsarerare,0.5–2.1per100000personsyears vs. 35.5 per 100 000 person-years for non-exercise-related OHCA in the Dutch study. This information should be used in an attempt to limit theanxiety regardingexercise-related fatal emergencies, thereby encouraging the general public and recommending exercise at different levels. On the other hand, in a previous study, Marijon et al. showed that competitive athletes aged 35 years or younger seem to have a higher risk of SCA than recreational athletes, which might influence the debate regarding screening programmes for competitive athletes. Secondly, both studies show quite good survival potential for these patients, especially compared with patients with non-exercise-related cardiac arrest. Exercise-related OHCA was also associated with better outcome than non-exerciserelated OHCA in the Dutch study after adjusting for factors