Hypothesised mechanisms of swimming-related death: A systematic review

Chad A. Asplund, Lawrence L. Creswell

Research output: Contribution to journalReview articlepeer-review

15 Scopus citations


Background Recent reports from triathlon and competitive open-water swimming indicate that these events have higher rates of death compared with other forms of endurance sport. The potential causal mechanism for swimming-related death is unclear. Objective To examine available studies on the hypothesised mechanisms of swimming-related death to determine the most likely aetiologies. Material and methods MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews (1950 to present) were searched, yielding 1950 potential results, which after title and citation reviews were reduced to 83 possible reports. Studies included discussed mechanisms of death during swimming in humans, and were Level 4 evidence or higher. Results A total of 17 studies (366 total swimmers) were included for further analysis: 5 investigating hyperthermia/hypothermia, 7 examining cardiac mechanisms and responses, and 5 determining the presence of pulmonary edema. The studies provide inconsistent and limited-quality or disease-oriented evidence that make definitive conclusions difficult. Conclusions The available evidence is limited but may suggest that cardiac arrhythmias are the most likely aetiology of swimming-related death. While symptoms of pulmonary edema may occur during swimming, current evidence does not support swimming-induced pulmonary edema as a frequent cause of swimming-related death, nor is there evidence to link hypothermia or hyperthermia as a causal mechanism. Further higher level studies are needed.

Original languageEnglish (US)
Pages (from-to)1360-1366
Number of pages7
JournalBritish journal of sports medicine
Issue number22
StatePublished - Nov 2016

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation


Dive into the research topics of 'Hypothesised mechanisms of swimming-related death: A systematic review'. Together they form a unique fingerprint.

Cite this