Implementation of Prehospital ECMO at the New York City Marathon – JEMS.com

Implementation of Prehospital ECMO at the New York City Marathon  JEMS.com

Rates of sudden cardiac arrest in male runners completing marathons and half-marathons increased significantly between 2020 and 2023 compared with prior As participation in marathons and half-marathons continues to climb, rates of cardiac arrest among long distance male runners have increased this decade.1 Last fall, more than 59,000 runners participated in one of the world’s largest races: the annual TCS New York City Marathon.2 Starting in Staten Island, athletes run through each of NYC’s five boroughs and finish the last two and a half miles of the race in Central Park. On race day, medical staff are available throughout the course to address incidents from minor injuries to life-threatening conditions.

While non-emergent issues, such musculoskeletal complaints and minor trauma predominate, a 2025 JAMA publication revealed that rates of sudden cardiac arrest (SCA) in male runners completing full or half-marathons increased significantly between 2020 to 2023 compared with prior decades.1 While the resuscitation rate in witnessed cardiac arrest is comparatively higher than unwitnessed arrests, Advanced Cardiovascular Life Support (ACLS) has its limitations. ACLS is most successful if the underlying problem is immediately reversible, such as ventricular tachycardia or a tension pneumothorax. If the underlying problem is not expeditiously reversible, such as an acute myocardial infarction or saddle pulmonary embolus, the rationale for ACLS is to maintain continuous blood flow until a