Epidemiology and outcomes of out-of-hospital cardiac arrests at sport and recreational events in England, 2015-2022.

Background: Previous studies suggest favourable outcomes for patients experiencing exercise-related out-of-hospital cardiac arrest (OHCA). This study aimed to examine the characteristics and outcomes of OHCAs occurring at sports and recreational events in England. Methods: Data were obtained from the OHCA Outcomes registry for cases between 2015 and 2022 where resuscitation was attempted. Descriptive statistics were used to compare OHCA characteristics with outcomes: return of spontaneous circulation (ROSC) sustained to hospital handover and survival (discharge or 30-day). Logistic regression identified factors influencing outcomes. Results: Of EMS-resuscitated OHCAs, 0.5 % (N = 1316) occurred at sports and recreational events. ROSC sustained to hospital handover occurred in 43 % of cases, and 25 % survived. Most patients were male and over 65-years. These OHCAs were more likely to be witnessed (73.5 %), receive bystander cardiopulmonary resuscitation (CPR) (91.8 %), have an automated external defibrillator (AED) attached (34.3 %) and receive an ambulance response within 7-min (43.5 %). Survival was 36 % in cases that were bystander witnessed with an initial shockable rhythm. ROSC to hospital handover improved survival further (93.6 %). Regression analysis indicated initial shockable rhythm had the greatest impact on outcomes (ROSC: odds ratio (OR) = 2.97, 95 %CI = 2.25-3.92; survival: OR = 4.25, 95 %CI = 2.96-6.10). Conclusion: OHCA at sports/recreational events are rare but show better outcomes than the general population, driven by higher rates of witnessed arrests, bystander interventions and initial shockable rhythms. Findings underscore the importance of strengthening the chain of survival through early recognition, CPR training, and AED.