Boston Marathon to offer CPR training after study finds it could have prevented deaths in past races

By Deborah Kotz, Globe Staff

At least 1,000 runners and family members will be trained in CPR the weekend before this year’s Boston Marathon, after local researchers found that immediate use of the procedure could have saved many of the runners who have died from cardiac arrest during a marathon or half-marathon.

The Massachusetts General Hospital study, published today in the New England Journal of Medicine, examined 59 runners whose hearts stopped during races over the last decade in the United States. Among 31 cases with complete clinical data, the researchers found that all eight who survived had received cardiopulmonary resuscitation from a bystander. In comparison, just 10 of the 23 who died received CPR.

“The number one predictor of survival of cardiac arrest during a race was whether a runner had access to bystander CPR,” said study leader Dr. Aaron Baggish, associate director of the cardiovascular performance program at Mass. General. Teaching basic chest compressions to marathon participants and race observers -- a form of CPR than doesn’t involve mouth-to-mouth resuscitation -- might lead to fewer deaths in the future, he added.

Bob Pohl’s life was saved by a bystander who performed CPR last October after he collapsed in full cardiac arrest about 200 feet from the finish line of the Baltimore half-marathon. “I was very fortunate,” the 55-year-old from Marriottsville, Md., a longtime runner who had had no previous heart problems, said in a telephone interview. “If I had the attack at home, I probably would have died.”

A Boston marathoner’s heart stopped a few years ago while he was passing through Kenmore Square, but he survived as well after a bystander gave him CPR. Hoping that this year’s runners will be as lucky if they collapse, the Boston Athletic Association, which organizes the marathon, will offer free CPR training for participants and family members at the Boston Marathon Expo held the weekend before the April race.

While the race has 28 medical stations along the 26.2-mile course, roving volunteers every half-mile with portable defibrillators, and two medical tents at the finish line, runners trained in CPR can help “bridge the gap between racers and various trained medical professionals,” said Tom Grilk, executive director of the Boston Athletic Association.

The study highlighted the importance of speed in starting CPR, which was performed on survivors within an average of 90 seconds of their collapsing, compared with more than five minutes for those who died despite attempts to revive them with CPR.

The 30-minute training -- to be administered in cooperation with the American Red Cross and American Heart Association -- is enough to teach the basics so that people can perform CPR until medical help arrives, said Grilk, even though it won’t provide formal certification in CPR. If successful, Grilk said the BAA might hold similar training sessions in 2013 in cities and towns along the marathon route.

“This type of training can give someone the basics to actually save someone’s life,” said Dr. Erika Feller, a cardiologist at the University of Maryland Medical Center who treated Pohl. “In these situations, minutes really count.”

Like Pohl, many marathon runners who experience heart attacks at the end of a race had no indication from routine physicals beforehand that they were at increased risk. Cholesterol and blood pressure screenings, and an occasional exercise stress test don’t pick up all cases of atherosclerosis, nor do they detect life-threatening genetic abnormalities in the heart muscle.

“Certainly people who run marathons are in fabulous shape, but no one can completely get away from coronary artery disease,” said Feller. “Being male, increased age, and genetics are all things that seem to trump being in shape.”

That said, cardiac arrests occurred in only 1 in 100,000 marathon runners who participated in races from 2000 to 2010, and just 42 people died, according to the new study. Baggish and his colleagues did find that men were at a five times greater risk than women and the incidence for men doubled over the past decade, to about 1 in 50,000 today.

“The age of marathon runners is skewing slightly upward as those who’ve led previously sedentary lives may be turning more often to marathons to improve their health,” Baggish explained.

Some runners might be more predisposed to heart problems after a marathon if they don’t stay in shape the rest of the year and then push to complete their race training -- a phenomenon that could be on the rise. “We don’t really know for sure, but it might have something to do with it,” said Feller.

Perhaps just as pressing as delivering immediate CPR to a runner in cardiac arrest is recognizing signs of a heart attack -- where plaque ruptures inside heart arteries and blocks blood flow without necessarily halting the heartbeat -- which occurs more commonly than cardiac arrest in runners at the finish line.

“Many runners at the end of a race may have shortness of breath, excessive sweating, and chest pain, and attribute those symptoms to exhaustion or dehydration,” said Dr. Navin Kapur, an interventional cardiologist at Tufts Medical Center who treated three heart attack patients immediately after they participated in last year’s Boston Marathon. While the medics at the marathon took the appropriate measures in the patients Kapur treated, he added, some on site at races fail to recognize signs of a heart attack and don’t perform electrocardiograms to evaluate the heart’s pumping action.

Guillermo Roman was fortunate to get immediate care for his life-threatening heart attack, which occurred soon after he completed the Boston Marathon last year. “The lights went out and the next thing I remember was waking up four days later,” said the 60-year-old from Coral Springs, FL. After getting emergency cardiac care at Tufts and bypass surgery a month later in Miami, Roman said he’s now back to running and hoping to train for a 5K race.

“We’ll see where we go from there,” he said. “I want to run a marathon again, but my wife will kill me.”