Exercise related vs. non exercise related out of hospital cardiac arrest

Max Maria Meertens (Köln)1, S. Macherey-Meyer (Köln)1, S. Heyne (Köln)1, S. Braumann (Köln)1, S. Baldus (Köln)1, S. Lee (Köln)1, C. Adler (Köln)1

1Herzzentrum der Universität zu Köln Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin Köln, Deutschland



Physical activity prevents cardiovascular disease, but it may also trigger acute cardiac events in patients with ischemic heart disease. The chance of surviving an out-of-hospital cardiac arrest (OHCA) remains low, in spite of a lot of public awareness campaigns. Prior studies signaled that the chance of surviving an OHCA is increased if the cardiac arrest occurs exercise related.  



The aim of this study was to evaluate the differences between patients undergoing exercise related (ER) OHCA and OHCA during daily activity (DA) in an urban setting. 



We reviewed all OHCA from 2014 to 2021 brought to the cardiac arrest center of a tertiary hospital. Patients with more than >80% missing data or missing data on whether their OHCA occurred exercise related or not were excluded.



501 OHCA patients were reviewed of which 457 (ER 38 patients vs. DA 419) were included in the analysis. Patients suffering an ER-OHCA were younger (ER 53.3 vs. DA 63.0 years, p<0.001), mostly male (ER 89.5% vs. 74.9%, p=0.028) and had higher in-hospital survival (ER 65.8% vs. 47.0%, p=0.02). 

The ER-OHCA cohort received bystander cardiopulmonary resuscitation (ER 65.9% vs. DA 53.0%, p<0.001) to a higher extend and had a shorter no-flow time (ER 1.4 vs. DA 2.7 min, p=0.02). ER-OHCA patients more often presented with a shockable rhythm (ER 78.9% vs. DA 64.4%, p<0.001). 

At hospital admission ER-OHCA patients had a higher initial pH (ER 7.1 vs. DA 7.0, p<0.001), but a similar lactate compared with DA-OHCA patients (ER 8.00 vs. DA 8.04 mmol/l, p=0.97). No differences were seen regarding the cause of the OHCA (figure 1). In both groups myocardial infarction (ER 44.7% vs. DA 42.3%) were the most common cause, but an arrhythmic event (ER 34.2% vs. DA 25.8%) was more often the cause  in ER OHCAs. 


Based on this observational data, patients suffering an ER-OHCA, differ in all substantial characteristics and also in the first line response they receive from DA-OHCA patients. The better in-hospital survival of the ER-OHCA cohort might be driven by these beneficial differences. This study underlines the need for public awareness for the importance of fast first responders. Further research is required to evaluate the also previously described underrepresentation of women in ER-OHCA cohorts.


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