Causes of Sudden Death During the Triathlon—Reply

In Reply: We agree with Dr Constantini and colleagues that understanding the precise mechanisms and circumstances underlying these sudden deaths would be ideal and aid substantially in the prevention of such catastrophes in the future. They are correct to suggest that a simple loss of consciousness, which would be readily identifiable on the ground, may not be as easily noted in the water. Although rescue personnel are situated on rafts or watercraft during triathlons, identification and rescue is particularly challenging in the open water environment.¹ Although marathon runners with cardiac arrest have a reasonable chance at successful resuscitation with defibrillation,² this is not as likely when athletes experience life-threatening events in open water. Furthermore, it is likely that triathlon competition includes novice swimmers who train primarily in pools; they may be unaccustomed to open water competitive swimming, during which it is not possible to rest or stop, and drowning may result. We agree with the suggestion for improved and systematic monitoring of the swim competition.