SUDDEN CARDIAC ARREST DURING MASS RUNNING EVENTS IN THE CONTEXT OF THE 2025 EUROPEAN RESUSCITATION COUNCIL GUIDLINES AND CURRENT SCIENTIFIC EVIDENCE
Abstract
Introduction and objective: Sudden cardiac arrest (SCA) during outdoor sport training is a complication where a quick response from medical professionals is crucial for increasing chances of survival. In parallel with the global growth in running events, there is a need to implement new recommendations and technologies to improve prevention, detection, and treatment of SCA among runners.
Review Methods: A comprehensive literature review was conducted, analyzing studies indexed in PubMed, Google Scholar, and the official ERC Guidelines from 2021 and 2025.
Key findings: Recent data suggest that, although the number of SCA cases in mass running events has remained relatively stable over the past decade, running-related deaths have declined. These outcomes are likely attributable to significant improvements in emergency action planning, widespread AED availability, and enhanced first-aid education. There are also new ideas that can further improve those outcomes, not only in treatment but also in SCA prophylaxis. New preventive and diagnostic strategies, such as point-of-care blood gas analysis (POC BGA) and risk-profiling patient triage, focus primarily on early triage and smartwatch pulse-detector systems, offering a new perspective on more rapid detection of SCA during outdoor activity. Advances in treatment focus on optimizing the prehospital chain of survival through mobile AED teams, GPS-enabled responder coordination, and structured “field-of-play” protocols. Further research is needed to reduce the time to defibrillation and improve neurological outcomes during endurance events.
References
Armstrong, M., Paternostro-Bayles, M., Conroy, M. B., Franklin, B. A., Richardson, C., & Kriska, A. (2018). Preparticipation Screening before Physical Activity in Community Lifestyle Interventions. Translational Journal of the American College of Sports Medicine, 3(22), 176–180. https://doi.org/10.1249/TJX.0000000000000073
Bohm, P., Meyer, T., Narayanan, K., Schindler, M., Weizman, O., Beganton, F., Schmied, C., Bougouin, W., Barra, S., Dumas, F., Varenne, O., Cariou, A., Karam, N., Jouven, X., & Marijon, E. (2023). Sports-related sudden cardiac arrest in young adults. EP Europace, 25(2), 627–633. https://doi.org/10.1093/europace/euac172
Bohm, P., Scharhag, J., & Meyer, T. (2016). Data from a nationwide registry on sports-related sudden cardiac deaths in Germany. European Journal of Preventive Cardiology, 23(6), 649–656. https://doi.org/10.1177/2047487315594087
Brock, R., Krammel, M., Kornfehl, A., Veigl, C., Schnaubelt, B., Neymayer, M., Grassmann, D., Zeiner, A., Aigner, P., Gabriel, R., Drapalik, S., & Schnaubelt, S. (2025). Emergency Point-of-Care Blood Gas Analysis During Mass Gathering Events: Experiences of the Vienna City Marathon. Journal of Clinical Medicine, 14(7), 2504. https://doi.org/10.3390/jcm14072504
Chen, Y.-C., Wu, K.-H., Hsiao, K.-Y., Hung, M.-S., Lai, Y.-C., Chen, Y.-S., & Chang, C.-Y. (2019). Factors associated with outcomes in traumatic cardiac arrest patients without prehospital return of spontaneous circulation. Injury, 50(1), 4–9. https://doi.org/10.1016/j.injury.2018.07.010
Dami, F., Heymann, E., Pasquier, M., Fuchs, V., Carron, P.-N., & Hugli, O. (2015). Time to identify cardiac arrest and provide dispatch-assisted cardio-pulmonary resuscitation in a criteria-based dispatch system. Resuscitation, 97, 27–33. https://doi.org/10.1016/j.resuscitation.2015.09.390
Dostal, J., Hybska, T., Saganelidze, K., Pudil, R., & Stasek, J. (2024). Autonomic dysfunction as a possible cause of sudden cardiac death in swimming sports. Frontiers in Cardiovascular Medicine, 11, 1443214. https://doi.org/10.3389/fcvm.2024.1443214
Harmon, K. G., Drezner, J. A., Wilson, M. G., & Sharma, S. (2014). Incidence of sudden cardiac death in athletes: a state-of-the-art review. British Journal of Sports Medicine, 48(15), 1185–1192. https://doi.org/10.1136/bjsports-2014-093872
Herlitz, J. (2003). A short delay from out of hospital cardiac arrest to call for ambulance increases survival. European Heart Journal, 24(19), 1750–1755. https://doi.org/10.1016/S0195-668X(03)00475-5
Jakobsen, L. K., Bang Gram, J. K., Grabmayr, A. J., Højen, A., Hansen, C. M., Rostgaard-Knudsen, M., Claesson, A., & Folke, F. (2025). Semi-autonomous drone delivering automated external defibrillators for real out-of-hospital cardiac arrest: A Danish feasibility study. Resuscitation, 208, 110544. https://doi.org/10.1016/j.resuscitation.2025.110544
Kim, J. H., Rim, A. J., Miller, J. T., Jackson, M., Patel, N., Rajesh, S., Ko, Y.-A., DiGregorio, H., Chiampas, G., McGillivray, D., Holder, J., & Baggish, A. L. (2025). Cardiac Arrest During Long-Distance Running Races. JAMA, 333(19), 1699. https://doi.org/10.1001/jama.2025.3026
Kinoshi, T., Tanaka, S., Sagisaka, R., Hara, T., Shirakawa, T., Sone, E., Takahashi, H., Sakurai, M., Maki, A., Takyu, H., & Tanaka, H. (2018). Mobile Automated External Defibrillator Response System during Road Races. The New England Journal of Medicine, 379(5), 488–489. https://doi.org/10.1056/NEJMc1803218
Lott, C., Karageorgos, V., Abelairas-Gomez, C., Alfonzo, A., Bierens, J., Cantellow, S., Debaty, G., Einav, S., Fischer, M., González-Salvado, V., Greif, R., Metelmann, B., Metelmann, C., Meyer, T., Paal, P., Peran, D., Scapigliati, A., Spartinou, A., Thies, K., … Deakin, C. D. (2025). European Resuscitation Council Guidelines 2025 Special Circumstances in Resuscitation. Resuscitation, 215, 110753. https://doi.org/10.1016/j.resuscitation.2025.110753
Manabe, T., Kato, J., & Yamasawa, F. (2024). Sudden cardiac arrest during marathons among young, middle-aged, and senior runners. Resuscitation, 204, 110415. https://doi.org/10.1016/j.resuscitation.2024.110415
Marijon, E., Bougouin, W., Karam, N., Beganton, F., Lamhaut, L., Perier, M.-C., Benameur, N., Tafflet, M., Beal, G., Hagege, A., Le Heuzey, J.-Y., Desnos, M., Spaulding, C., Carré, F., Dumas, F., Celermajer, D. S., Cariou, A., & Jouven, X. (2015). Survival from sports-related sudden cardiac arrest: In sports facilities versus outside of sports facilities. American Heart Journal, 170(2), 339-345.e1. https://doi.org/10.1016/j.ahj.2015.03.022
Marijon, E., Tafflet, M., Celermajer, D. S., Dumas, F., Perier, M.-C., Mustafic, H., Toussaint, J.-F., Desnos, M., Rieu, M., Benameur, N., Le Heuzey, J.-Y., Empana,
J.-P., & Jouven, X. (2011). Sports-Related Sudden Death in the General Population. Circulation, 124(6), 672–681. https://doi.org/10.1161/CIRCULATIONAHA.110.008979
Marijon, E., Uy-Evanado, A., Dumas, F., Karam, N., Reinier, K., Teodorescu, C., Narayanan, K., Gunson, K., Jui, J., Jouven, X., & Chugh, S. S. (2016). Warning Symptoms Are Associated With Survival From Sudden Cardiac Arrest. Annals of Internal Medicine, 164(1), 23–29. https://doi.org/10.7326/M14-2342
Nabecker, S., De Raad, T., Abelairas-Gomez, C., Breckwoldt, J., Chakroun-Walha, O., Farquharson, B., Hunyadi-Antičević, S., Lott, C., Schnaubelt, S., Yeung, J., Lockey, A., Greif, R., Conaghan, P., & Mackie, K. (2025). European Resuscitation Council Guidelines 2025 Education for Resuscitation. Resuscitation, 215, 110739. https://doi.org/10.1016/j.resuscitation.2025.110739
Ruegsegger, G. N., & Booth, F. W. (2018). Health Benefits of Exercise. Cold Spring Harbor Perspectives in Medicine, 8(7), a029694. https://doi.org/10.1101/cshperspect.a029694
Scquizzato, T., Landoni, G., Consolo, F., & Scandroglio, A. M. (2024). Google’s loss of pulse detection: Unwitnessed cardiac arrest ‘witnessed’ by a smartwatch. Resuscitation, 202, 110376. https://doi.org/10.1016/j.resuscitation.2024.110376
Tanaka, H., Kinoshi, T., Tanaka, S., Sagisaka, R., Takahashi, H., Sone, E., Hara, T., Takeda, Y., & Takyu, H. (2022). Prehospital interventions and neurological outcomes in marathon-related sudden cardiac arrest using a rapid mobile automated external defibrillator system in Japan: a prospective observational study. British Journal of Sports Medicine, 56(21), 1210–1217. https://doi.org/10.1136/bjsports-2021-104964
Van Den Beuken, W. M. F., Nideröst, B., Goossen, S. A., Kooy, T. A., Demirtas, D., Autar, D., Loer, S. A., Eberl, S., Van Halm, V. P., Winkler, B. E., Van Schuppen, H., Tuinman, P. R., Schwarte, L. A., & Schober, P. (2025). Automated cardiac arrest detection and emergency service alerting using device-independent smartwatch technology: proof-of-principle. Resuscitation, 213, 110657. https://doi.org/10.1016/j.resuscitation.2025.110657
Copyright (c) 2026 Zofia Czaplińska-Paszek, Kornelia Rynkiewicz, Natalia Bogusz, Sławomir Paszek
This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.
