{"id":385471,"date":"2026-10-28T14:26:08","date_gmt":"2026-10-28T14:26:08","guid":{"rendered":"https:\/\/www.newsbeep.com\/us-ny\/385471\/"},"modified":"2026-10-28T14:26:08","modified_gmt":"2026-10-28T14:26:08","slug":"implementation-of-prehospital-ecmo-at-the-new-york-city-marathon","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/us-ny\/385471\/","title":{"rendered":"Implementation of Prehospital ECMO at the New York City Marathon"},"content":{"rendered":"

\"\"\"\"Shutterstock\/Rabanser
\n Rates of sudden cardiac arrest in male runners completing marathons and half-marathons increased significantly between 2020 and 2023 compared with prior decades.Onsite extracorporeal membrane oxygenation was deployed for the first time at the TCS New York City Marathon and the RBC Brooklyn Half Marathon during the 2025-26 race season.A meta-analysis indicated that extracorporeal cardiopulmonary resuscitation improves survival rates and neurological outcomes compared to conventional cardiopulmonary resuscitation.<\/p>\n

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\u2019s largest races: the annual TCS New York City Marathon.2 Starting in Staten Island, athletes run through each of NYC\u2019s 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.<\/p>\n

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<\/p>\n

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 definitive intervention can be delivered. The efficacy of ACLS as a temporizing measure decays with time, as chest compressions provide limited blood flow.3<\/p>\n

Extracorporeal membrane oxygenation (ECMO) addresses this significant limitation of ACLS by providing maximal percutaneous circulatory and metabolic support.<\/p>\n

In communities hosting large-scale endurance events, hospital transport times are significantly increased on race day due to road closures and crowd congestion. Given that successful resuscitation from cardiac arrest is time-dependent, these critical delays can significantly worsen patient outcomes. Deploying the capabilities for onsite ECMO allows for rapid initiation of life-saving measures without waiting for hospital transport. During the 2025-26 race season, onsite ECMO was deployed for the first time in the finish line medical tents at both the TCS NYC Marathon as well as the RBC Brooklyn Half Marathon, encompassing more than 90,000 total runners between both races.<\/p>\n

ECMO is a lifesaving technology pioneered by Dr. Robert H. Bartlett and his team. The main purpose of ECMO was to function as a long-term \u201cbypass machine\u201d with an artificial heart and\/or lung, which traditional bypass machines could not accomplish. The process of cannulating an artery and vein to initiate the ECMO circuit can be completed expeditiously, typically within ten minutes with experienced personnel. By draining deoxygenated blood from the venous system, removing carbon dioxide (CO\u2082), oxygenating the blood via a membrane oxygenator, and returning the oxygenated blood to the patient\u2019s arterial system, adequate circulation is effectively restored in cases of SCA.<\/p>\n

There is a strong signal that extracorporeal cardiopulmonary resuscitation (ECPR)\u2014 the use of ECMO in cardiac arrest care\u2014improves outcomes compared with traditional ACLS. In a 2008 prospective observational study, Chen et al compared conventional CPR outcomes to those of ECPR for an in-hospital cohort.4 A total of 113 patients received conventional CPR and 59 received ECPR. Of that, 28.8% of the ECPR group survived to discharge versus 12.3% of the conventional group. A year post hospital discharge, 18.6% of the extracorporeal cohort was alive versus 9.7% of the conventional group. Recent meta-analyses have reaffirmed the ECPR benefit and detail the mounting evidence that ECPR increases survival with improved neurologic outcomes\u2014a critical primary outcome in cardiac arrest research. Another meta-analysis highlights the benefits of ECPR over conventional CPR in patients suffering out-of-hospital cardiac arrest (OHCA), an important caveat when applying this data to endurance athletes.5, 6<\/p>\n

While cardiac arrest rates among long-distance runners remained stable between 2010-2019 compared with 2000-2009, rates significantly increased during 2020-2023 from 0.58 to 0.81 per 100,000 participants, which reflects a nearly 50% increase in total cases.1 The most significant rate increase was in male marathon runners, rising from 1.43 per 100,000 in 2010\u20132019 to 2.79 per 100,000 in 2020\u20132023. Conversely, rates among women remained much lower (0.19 per 100,000 from 2010-2023) [1]. The rising rates in males may be attributed to undiagnosed structural heart disease or early developing atherosclerosis.7 Additionally, the impact of the COVID-19 pandemic reduced regular and timely access to preventative healthcare, which may have contributed to increased rates of undiagnosed cardiac disease.8 Lastly, global warming may be contributing to the increased number of serious medical events. In a study of Singapore Marathon casualties, every one degree increase in heat index resulted in a 22% rise in severe casualty numbers.9<\/p>\n

There is a distinct bimodal age distribution in the etiology and prognosis of runners experiencing cardiac arrests during endurance events. Older athletes are most likely to suffer from coronary artery disease (CAD). Conversely, younger athletes are more likely to present with either congenital or inherited cardiac conditions\u2014such as hypertrophic cardiomyopathy (HCM) or arrhythmogenic right ventricular dysplasia (AVRD)\u2014or no clear structural abnormality at all on autopsy.10,11 Surprisingly, compared with younger athletes, older runners exhibit better survival rates from SCA during endurance races. These paradoxical outcomes are likely secondary to older runners sustaining arrests secondary to shockable ventricular dysrhythmias in the setting of CAD, which is more responsive to conventional ACLS.12 Importantly, studies suggest that younger patients suffering refractory cardiac arrest demonstrate improved survival rates with the immediate initiation of ECPR.1 In some cases, ECMO has been shown to reduce mortality from 80\u201390% to roughly 35\u201350%.13 For these reasons, the medical staff at the TCS NYC Marathon and the RBC Brooklyn Half Marathon believed the addition of onsite ECMO capabilities to be of vital importance for the nearly one hundred thousand participating athletes.<\/p>\n

Given resource constraints, event medical staff are frequently challenged to exhibit medical stewardship on race day. During half marathons and marathons, 65% of cardiac arrests occur within the last quarter of the course,2 thus the ECMO circuits were staged at the primary finish line medical tent, also called F1. In the event of a runner experiencing SCA within the final segment of the course, ACLS would be started on scene, and race personnel would transport the patient with compressions in progress via stretcher-capable utility task vehicles (UTV\u2019s) to F1. After eight minutes of ACLS without return of spontaneous circulation, sufficient time for two complete cycles with rhythm analysis, ECMO cannulation and initiation of the circuit would take place within the tent\u2019s resuscitation area prior to hospital transport.2<\/p>\n

ECMO cannulation is typically performed with an ECMO circuit specialist at the bedside, called a perfusionist, under the supervision of an ECMO-trained surgeon.14 Prehospital ECMO additionally requires the use of specialized transport teams and deployable resources, allowing for rapid initiation of the ECMO circuit in the field prior to transport. Buy-in from receiving hospitals with existing ECMO capabilities is also necessary for the safe and efficient transfer of patients cannulated in the field. Given the degree of coordination required between all stakeholders\u2014race-day medical and operations staff, ECMO specialists, critical care transport, and receiving institutions\u2014integration of ECPR into large scale events such as these requires significant pre-planning, and ideally an established mass gathering medicine system already capable of orchestrating satisfactory ACLS care in cases of SCA.<\/p>\n

Given the variety of potential pathology, the distance covered along the course, and the significant transport delays due to road closures and crowds, large-scale endurance events like the TCS NYC Marathon and the RBC Brooklyn Half Marathon pose real challenges for the medical staff. Onsite ECMO capabilities allow for prompt circulatory support for the most critical patients who do not respond to standard resuscitative measures. ECPR would not replace conventional ACLS but rather begins when CPR and defibrillation prove inadequate\u2014a grim reality for a percentage of athletes suffering SCA. As participation in endurance events increases and the risk of cardiac arrests remains significant, the addition of onsite ECMO capabilities represents an important consideration for comprehensive emergency preparedness during long-distance races.<\/p>\n

More from JEMS<\/p>\n

The Longest ECMO Transport<\/a><\/p>\n

ECMO-equipped SUVs See Success in Minnesota<\/a><\/p>\n

How Physicians Perform Prehospital ECMO on the Streets of Paris<\/a><\/p>\n

Extracorporeal Membrane Oxygenation and EMS<\/a><\/p>\n

References<\/p>\n

1. Kim, J. H., Rim, A. J., Miller, J. T., Jackson, M., Patel, N., Rajesh, S., Ko, Y.-A., DiGregorio, H., Chiampas, G., McGillivray, D., Holder, J., & Baggish, A. L. (2025). Cardiac arrest during long-distance running races. JAMA, 333(19), 1699.<\/p>\n

2. Fitzpatrick, C. B., Groden, P., Carroll, M. T., Saunders, P. C., & Friedman, M. S. (2026). Optimizing the circuit: A critical enhancement at the 2025 NYC Marathon. The American Journal of Emergency Medicine, 103, 213\u2013214.<\/a> https:\/\/doi.org\/10.1016\/j.ajem.2026.02.009<\/a><\/p>\n

3. Di Fronzo, P., Gaetti, G., Marcassa, D., Gervasi, V., Dardour, O., Pedretti, A., & Gambol\u00f2, L. (2025). The impact of acls training in the management of cardiac arrest: A narrative review. Epidemiologia, 6(4), 61. https:\/\/doi.org\/10.3390\/epidemiologia6040061<\/a><\/p>\n

4. Chen, Y.-S., Lin, J.-W., Yu, H.-Y., Ko, W.-J., Jerng, J.-S., Chang, W.-T., Chen, W.-J., Huang, S.-C., Chi, N.-H., Wang, C.-H., Chen, L.-C., Tsai, P.-R., Wang, S.-S., Hwang, J.-J., & Lin, F.-Y. (2008). Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: An observational study and propensity analysis. The Lancet, 372(9638), 554\u2013561. https:\/\/doi.org\/10.1016\/S0140-6736(08)60958-7<\/a><\/p>\n

5. Taccone, F. S., Minini, A., Avalli, L., Alm-Kruse, K., Annoni, F., Bougouin, W., Burrell, A., Cariou, A., Coppalini, G., Grunau, B., Hifumi, T., Heng Yen, H., Jouven, X., Jung, J. S., Lorusso, R., Maekawa, K., M\u00f8rk, S. R., Rob, D., Schober, A., Shah, A. P., Stoll, S. E., Suverein,<\/p>\n

M. M., Nakashima, T., Vande Poll, M. C. G., Yannopoulos, D., Kim, W. Y., & Belohlavek, J. (2024). Impact of extracorporeal cardiopulmonary resuscitation on neurological prognosis and survival in adult patients after cardiac arrest: An individual pooled patient data meta-analysis. Resuscitation, 202, 110357. https:\/\/doi.org\/10.1016\/j.resuscitation.2024.110357<\/a><\/p>\n

6. Low, C. J. W., Ling, R. R., Ramanathan, K., Chen, Y., Rochwerg, B., Kitamura, T., Iwami, T., Ong, M. E. H., & Okada, Y. (2024). Extracorporeal cardiopulmonary resuscitation versus conventional CPR in cardiac arrest: An updated meta-analysis and trial sequential analysis. Critical Care, 28(1), 57. https:\/\/doi.org\/10.1186\/s13054-024-04830-5<\/a><\/p>\n

7. Kim, J. H., Malhotra, R., Chiampas, G., d\u2019Hemecourt, P., Troyanos, C., Cianca, J., Smith, R. N., Wang, T. J., Roberts, W. O., Thompson, P. D., & Baggish, A. L. (2012). Cardiac arrest during long-distance running races. New England Journal of Medicine, 366(2), 130\u2013140.<\/a> https:\/\/doi.org\/10.1056\/NEJMoa1106468<\/a><\/p>\n

8. Raisi-Estabragh, Z., & Mamas, M. A. (2023). Cardiovascular health care implications of the covid-19 pandemic. Heart Failure Clinics, 19(2), 265\u2013272.<\/a> https:\/\/doi.org\/10.1016\/j.hfc.2022.08.010<\/a><\/p>\n

9. Poh, J., & Anantharaman, V. (2025). Casualties during marathon events and implications for medical support. Healthcare, 13(17), 2249.<\/a> https:\/\/doi.org\/10.3390\/healthcare13172249<\/a><\/p>\n

10. Kim, J. H., Martinez, M. W., Guseh, J. S., Krishnan, S., Gray, B., Harmon, K. G., Papadakis, M., Phelan, D. M., Stewart, K., Levine, B. D., & Baggish, A. L. (2024). A contemporary review of sudden cardiac arrest and death in competitive and recreational athletes. The Lancet, 404, 2209\u20132222. https:\/\/doi.org\/10.1016\/S0140-6736(24)02086-5<\/a><\/p>\n

11. Halabchi, F., Seif-Barghi, T., & Mazaheri, R. (2011). Sudden cardiac death in young athletes; a literature review and special considerations in asia. Asian Journal of Sports Medicine, 2(1).<\/a> https:\/\/doi.org\/10.5812\/asjsm.34818<\/a><\/p>\n

12. Manabe, T., Kato, J., & Yamasawa, F. (2024). Sudden cardiac arrest during marathons among young, middle-aged, and senior runners. Resuscitation, 204, 110415.<\/a> https:\/\/doi.org\/10.1016\/j.resuscitation.2024.110415<\/a><\/p>\n

13. Wang, C. F., & Yandrapalli, S. (2025). Venovenous ECMO for refractory hypoxemia. In StatPearls. StatPearls Publishing. Retrieved from https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK560516\/<\/a><\/p>\n

14. Gajkowski, E. F., Herrera, G., Hatton, L., Velia Antonini, M., Vercaemst, L., & Cooley, E. (2022). Elso guidelines for adult and pediatric extracorporeal membrane oxygenation circuits. ASAIO Journal, 68(2), 133\u2013152.<\/a> https:\/\/doi.org\/10.1097\/MAT.0000000000001630<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"Shutterstock\/Rabanser Rates of sudden cardiac arrest in male runners completing marathons and half-marathons increased significantly between 2020 and…\n","protected":false},"author":2,"featured_media":385472,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[8],"tags":[89974,9174,9,24,55,54,56,27913],"class_list":["post-385471","post","type-post","status-publish","format-standard","has-post-thumbnail","category-new-york-city","tag-ecmo","tag-ems","tag-new-york","tag-new-york-city","tag-new-york-city-headlines","tag-new-york-city-news","tag-ny","tag-paramedic"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/us-ny\/wp-json\/wp\/v2\/posts\/385471","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/us-ny\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/us-ny\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-ny\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-ny\/wp-json\/wp\/v2\/comments?post=385471"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/us-ny\/wp-json\/wp\/v2\/posts\/385471\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-ny\/wp-json\/wp\/v2\/media\/385472"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/us-ny\/wp-json\/wp\/v2\/media?parent=385471"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-ny\/wp-json\/wp\/v2\/categories?post=385471"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-ny\/wp-json\/wp\/v2\/tags?post=385471"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}