Survival from sports-related sudden cardiac arrest: In sports facilities versus outside of sports facilities Eloi Marijon, MD, PhD, a,b,c,i Wulfran Bougouin, MD, a,b,d,i Nicole Karam, MD, a,b,c Frankie Beganton, MS, a Lionel Lamhaut, MD, a,b,f Marie-Cécile Perier, MPH, a,b Nordine Benameur, MD, g Muriel Tafflet, PhD, a,b Guillaume Beal, MS, a,b Albert Hagege, MD, b,c Jean-Yves Le Heuzey, MD, b,c Michel Desnos, MD, b,c Christian Spaulding, MD, a,b,c Francois Carré, MD, PhD, h Florence Dumas, MD, PhD, a,b David S. Celermajer, PhD, FRACP, e Alain Cariou, MD, a,b and Xavier Jouven, MD, PhD a,b,c Paris, France; Sydney, Australia; Lille, and Rennes, France Background We sought to evaluate frequency, characteristics, and outcomes of sudden cardiac arrest (SCA) during sports activities according to the location of occurrence (in sports facilities vs those occurring outside of sports facilities). Methods and results This is an observational 5-year prospective national French survey of subjects 10 to 75 years old presenting with SCA during sports (2005-2010), in 60 French administrative regions (covering a population of 35 million people). Of the 820 SCA during sports, 426 SCAs (52%) occurred in sports facilities. Overall, a substantially higher survival rate at hospital discharge was observed among SCA in sports facilities (22.8%, 95% CI 18.8-26.8) compared to those occurring outside (8.0%, 95% CI 5.3-10.7) (P b .0001). Patients with SCA in sports facilities were younger (42.1 vs 51.3 years, P b .0001) and less frequently had known cardiovascular diseases (P b .0001). The events were more often witnessed (99.8% vs 84.9%, 0.0001), and bystander cardiopulmonary resuscitation was more frequently initiated (35.4% vs 25.9%, P = .003). Delays of intervention were significantly shorter when SCA occurred in sports facilities (9.3 vs 13.6, P=0.03), and the proportion of initially shockable rhythm was higher (58.8% vs 33.1%, P b .0001). Better survival in sports facilities was mainly explained by concomitant circumstances of occurrence (adjusted odds ratio 1.48, 95% CI 0.88-2.49, P = .134). Conclusions Sports-related SCA is not a homogeneous entity. The 3-fold higher survival rate reported among sports- related SCA is mainly due to cases that occur in sports facilities, whereas SCA during sports occurring outside of sports facilities has the usual very low rate of survival. (Am Heart J 2015;170:339-345.e1.) Sudden cardiac arrest (SCA) during sports activities always attracts considerable media attention. To date, the problem of SCA during sports has been mainly viewed through the prism of young competitive athletes, 1-6 and little data have been available from the general population. We have recently reported the results of a large prospective 5-year French national program aiming to document the burden and outcomes of sports-related SCA from a general population perspective. 7 Our results, recently supported by data from the Netherlands, 11 have emphasized that, overall, sports-related SCA showed relatively good outcomes, compared to SCA not associated with sports activities. This better survival observed among sports-related SCAs may be the result of specific intrinsinc characteristics of sports participants (vs nonsports partic- ipants) and also from significant differences in the circumstances of occurences, notably the actions initiated by bystanders. To better understand this better outcome among sports-related SCA, we hypothesized that sports-- related SCA was not a homogeneous group and that the better survival during sports activities mainly reflects improved outcomes in SCA in sports facilities. In the present article, we thus sought to compare characteristics and outcomes of sports-related SCA be- tween occurrences in sports facilities versus those occurring outside of sports facilities. Materials and methods We performed an ad hoc analysis of a prospective observational 5-year national French survey of subjects 10 to 75 years old presenting with SCA during sports. The study design and population have been described previ- ously. 7-10 Briefly, this 5-year prospective study was carried From the a Paris Cardiovascular Research Center, European Georges Pompidou Hospital, Paris, France, b Paris Descartes University, Paris, France, c Cardiology Department, Georges Pompidou European Hospital, Paris, France, d Intensive Care Unit, Cochin Hospital, Paris, France, e Sydney Medical School, University of Sydney, Sydney, Australia, f Intensive Care Unit and SAMU 75, Necker Enfants-Malades Hospital, Paris, France, g Lille 2 University Hospital, University of Lille, Emergency Department and SAMU 59, Lille, France, and h Rennes 1 University, Pontchaillou Hospital, INSERM UMR, Rennes, France. i Equally contribution to the article. No conflict of interest. Primary funding source: French Institute of Health and Medical Research and French Society of Cardiology. Reprint requests: Eloi Marijon, MD, PhD, European Georges Pompidou Hospital, Cardiology Department, 20-40 rue Leblanc, 75908 Paris CEDEX 15, France. E-mail: eloi_marijon@yahoo.fr 0002-8703 © 2015 Published by Elsevier Inc. http://dx.doi.org/10.1016/j.ahj.2015.03.022