Incidence and characteristics of severe exercise-associated collapse at the world’s largest half-marathon

Abstract

Background Whilst many health benefits are associated with regular exercise, medical complications may occur during higher-intensity activities, such as long distance running contests. The most common complication is collapse. However, the incidence and characteristics of these collapses are not very well studied. Method This is a retrospective study of severe collapse, defined as a patient in need of advanced medical care after a collapse, during the large Gothenburg’s half marathon, Göteborgsvarvet . The study included 230,501 competitors during the study-period of 5 years (2013–2017) with data being collected from medical race tents and using ambulance data. Vital signs, treatment and blood gas samples were noted and analyzed. Results The incidence of severe collapse was 1.53 per 1000 starting runners. The average age for patients was 34 years old and no difference in incidence were seen between male and female runners. The typical collapsed runner presented with tachycardia, normal systolic blood pressure, elevated body temperature and metabolic acidosis. The most common medical encounter was exercise-associated collapse. Conclusion The incidence of severe collapse was similar to findings in other studies, even though this study was set in different part of the world. Typical characteristics of a collapsed runner were identified providing new information which could be beneficial in the medical planning of larger running competitions and future preventative interventions. Importantly, life threatening conditions seem uncommon; no case of hyponatremia and only two cases of hypoglycemia were seen.

Association between collapse and serum creatinine and electrolyte concentrations in marathon runners: a 9-year retrospective study

“…Creatinine results in collapsed and non-collapsed runners A raised serum creatinine level after a marathon is well recognised, but to our knowledge, this is the largest reported cohort of post-race serum creatinine results in collapsed marathon runners. Nearly three quarters of all collapsed runners recorded elevated serum creatinine levels, consistent with some previous smaller studies (16,24), although others suggest a much lower incidence, around 30-40% of marathon runners (11,17). However, the current study also shows comparisons to non-collapsed runners (controls) completing the same marathon course.…”

“…Even with these guidelines, the incidence of hyponatraemia is reported as between 8.2% (6) and 12.5%, even in asymptomatic volunteers (23). Data on serum potassium concentrations are reported less often, but hyperkalaemia has been reported in 16 % after completing a marathon (17,24). This study describes the serum sodium, potassium and creatinine changes observed in a cohort of runners immediately after a collapse during the Brighton (UK) Marathon, over a nine-year period (2010-2019) The Brighton Marathon is an annual event which has run since 2010.…”

Medical emergencies during running events

“…blutiger Auswurf, hämodynamische Instabilität, rechtsventrikuläre Belastung, Trikuspidalinsuffizienz [ 26 ] Sofortige therapeutische Antikoagulation, Katecholamine, moderate Flüssigkeitsgabe, O 2 -Applikation, umgehende Einweisung mit Reperfusionsmöglichkeit, instabile Patienten: Lyse erwägen [ 26 ] Orthostatische Dysregulation Hypotension mit (hyperadrenerge Form) und ohne Tachykardie (hypoadrenerge Form) bzw. mit Bradykardie (neurokardiogene Form), Bewusstlosigkeit [ 22 , 27 ] Konservative Maßnahmen: Sympathomimetika, orale Flüssigkeitszufuhr, Trendelenburg-Lagerung, „begleitetes Gehen“ zur Aktivierung der Muskelpumpe (cave: Hypertension im Liegen; [ 28 ]) Schienbeinkantensyndrom Belastungsschmerz im distalen Bereich der posteromedialen Tibiakante [ 29 ] Schonung, Analgesie [ 29 ] Schwerwiegender Kollaps Tachykardie, Hyperthermie, metabolische Azidose, Hypernatriämie [ 30 ] Symptomatisch, Stabilisierung des Kreislaufs [ 30 ] Tiefe Beinvenenthrombose Schmerzen, Krämpfe, Ödematisierung, Überwärmung, Zyanose, livide Verfärbung, Ödem [ 26 ] Symptomatische Therapie, klinischer Ausschluss Lungenarterienembolie [ 26 ] Traumatische Blutung Tachykardie, Hypotension, Kaltschweißigkeit, Rekapillarisierungszeit > 2 s [ 31 ] Blutstillung (Kompression, Tourniquet, Beckenschlinge), Tranexamsäure erwägen [ 31 ] Herzrhythmusstörungen (HRST) Tachykarde HRST: > 100/min; Bradykarde HRST: < 60/min; Palpitationen, Synkope, Übelkeit, Erbrechen, ACS, Herzinsuffizienz [ 25 ] Symptomatisch, Stabilisierung des Kreislaufs, siehe ILCOR-Leitlinien [ 25 ] Prellung (Kontusion) Druckschmerz, Weichteilschwellung, Bewegungseinschränkung [ 12 , 13 ] Analgesie, abschwellende Maßnahmen, Ruhigstellung [ 12 , 13 ] Zerrung/Dehnung (Distorsion) Schmerz über der betr. Bandstruktur, Weichteilschwellung, Bewegungseinschränkung, Dehnungsschmerz [ ...…”

“…Ein Großteil der Patienten benötigt keine medizinische Betreuung. Wird diese benötigt, spricht man von einem „schwerwiegenden Kollaps“ [ 30 ], der mit Tachykardie, Hyperthermie, metabolischer Azidose und Hypernatriämie als Zeichen der temporären Dehydratation einhergeht. Präklinisch stehen die ausführliche Anamnese und die Sicherung der Vitalfunktionen nach dem ABCDE-Schema im Mittelpunkt.…”

Vasopressin and Breathing: Review of Evidence for Respiratory Effects of the Antidiuretic Hormone

“…The other stimuli for AVP release include hypovolemia, hypotension, hypoxia, hypoglycemia, strenuous exercise, and angiotensin II (Ang II; Szczepanska-Sadowska et al, 2017). The same stimuli also promote increases in pulmonary ventilation and are often associated with life-threatening conditions (Doerschug et al, 2010;Frier, 2014;Thompson et al, 2016;Convertino et al, 2019;Lüning et al, 2019).…”