Monday, October 26, 2009

Detroit Half Marathon Deaths

The more I think about the deaths in the Detroit Half Marathon, the more freaked I get.

The facts:
  • three men died
  • all within 16 minutes
  • all within a mile and a half
  • age varied from 26 to 65
The reasoned conjecture:

It sounds like, from this article, that the initial anatomic pathology report was negative. If that is the case we can rule-out the following causes of death:
  • Acute myocardial infarction (leading candidate for the 65 year old)
  • Hypertrophic cardiomyopathy (a common explanation for when apparently healthy athletes keels over dead during athletics)
  • Electrolyte abnormalities. Chemistries should have been available within minutes and if there was massive rhabdomyolysis with hyperkalemia and hypocalcemia or acute hyponatremia with cerebral edema I would expect that would have been announced.
What's left:
  • Sudden cardiac death (SCD) in a anatomically normal heart. Deadly heart arrhythmia.
That's all I can come up with. The problem with sudden cardiac death is it doesn't explain the geographic and temporal clustering. SCD is essentially random. The patients would increase the risk by racing up their heart rate and going into a bit of oxygen debt. Additionally I ran past two of the three resuscitation efforts. They had defibrillators on site and immediate CPR. My gut says that with the great first response they should have been able to get at least one save if it was SCD. The victims were in good shape without long lists of co-morbidities. The one factor that blocks success of out-of-hospital resuscitation is time to first response and by all accounts that was not an issue here.

The paranoid conjecture

The Detroit running community has been whispering whether the water or Gator-ade at the Mile 12 hydration station could have been poisoned. That would explain the temporal/spatial clustering and the negative anatomic autopsy.

I hope some new data emerges in the next few days to reassure me, but right now I'm planning on running with my CamelBack and drinking my own water in New York.

Good link on cause of cardiac deaths in runners
The Sudden Cardiac Death Association (sponsored by MedTronic presumably) weighs in.

No comments:

Post a Comment