Outcomes Over Time of Sports-Related Sudden Cardiac Arrest

Quick Takes

  • Prevention of sudden cardiac arrest (SCA) in the general population remains a significant public health challenge.
  • Focusing on sports-related SCA, this study assessed temporal trends in incidence, management, and outcomes in the Greater Paris Area between 2005–2018.
  • The incidence of sports-related SCA remained relatively stable over time, but major improvements in bystander CPR and AED use led to a threefold increase in survival by the end of the study period, underscoring the need for continued promotion of prevention measures and basic life support education.

Study Questions:

Have the incidence, management, and outcomes of sports-related sudden cardiac arrest (SrSCA) changed over time?

Methods:

Cases from the Greater Paris Area that were included in this study were collected from 2005–2018 for the Paris-Sudden Death Expertise Center (Paris-SDEC) SrSCA Dataset. The incidence, prehospital management, and survival to hospital discharge of SrSCA among 18- to 75-year-olds were analyzed. Athletes were in organized sports programs or leisure-time sports activities. Demographic data, circumstances of collapse, location of SCA, and clinical outcomes were collected. Time of study was divided into six successive 2-year periods.

Results:

Among 377 SrSCA cases, 20 (5.3%) occurred in young competitive athletes: the remaining 357 (94.7%) occurred in middle-aged recreational sports participants. SrSCA incidence remained stable (6.24 vs. 7.00 per million inhabitants/year; p = 0.51) during the study period. There were no significant differences in patients’ mean age, sex (men 94.7% vs. 95.2%; p = 0.99), home location, and history of heart disease. However, frequency of bystander cardiopulmonary resuscitation (CPR; 34.9% vs. 94.7%), public automated external defibrillator (AED) use (1.6% vs. 28.8%), and survival to hospital discharge (23.8% vs. 66.7%) significantly improved when comparing the first study period to the last.

Conclusions:

1) Incidence of SrSCA remained relatively stable over time, 2) major improvements in bystander CPR and AED use led to a threefold increase in survival, and 3) education in resuscitation and screening/prevention should be optimized to reduce SrSCA and SCA in general.

Perspective:

This is a unique study assessing temporal trends in resuscitation efforts and SrSCA outcomes; it highlights the particular importance of emergency action planning in improving resuscitation and survival. The bystander CPR and survival rate were highest in sports facilities, likely due to investments in trained personnel and AED acquisition; consequently, over the same time frame, survival rates for SrSCA improved, but not all-comers SCA. Both AED use and survival to discharge improved the most in the last 4 years of the study period; factors were likely time needed for public education and deployment of AEDs.

Recognition of potential warning signs (chest pain, dyspnea on exertion) and screening for coronary artery disease in at-risk populations remain important SCA prevention strategies. Limitations include the observational (nonrandomized) design, and no data on bystander training in resuscitation or quality of CPR performed.

Keywords: Athletes, Arrhythmias, Cardiac, Cardiopulmonary Resuscitation, Chest Pain, Death, Sudden, Cardiac, Defibrillators, Dyspnea, Emergency Medical Services, Heart Arrest, Leisure Activities, Outcome Assessment, Health Care, Patient Discharge, Physical Exertion, Secondary Prevention, Sports, Survival Rate


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