What is commotio cordis?
Commotio cordis occurs when a blow, usually from fast-flying objects such as baseballs and hockey pucks, to a specific part of the chest occurs during a part of the cardiac cycle that disrupts the heart’s electrical activity. Blows to the chest during contact sports like karate and soccer can also trigger the event.
The result is a life-threatening arrhythmia, or irregular heartbeat, leading to cardiac arrest. (Cardiac arrest is not the same as a heart attack, which occurs when blood flow to the heart is blocked.) The arrhythmia involved is usually ventricular fibrillation, which is when the lower chambers of the heart contract rapidly, preventing the heart from pumping. blood to the rest of the body. (In fact, a study in an anesthetized pig helped researchers learn this).
Similar to what happened to Hamlin, people who experience commotio cordis don’t always lose consciousness immediately. About 20% of people can continue to play their sport and even talk for a few seconds before collapsing.
It occurs most often in teenage boys playing competitive sports (average age 15 years) and is considered the second cause of sudden death in young athletes after hypertrophic cardiomyopathy, a disease that causes the heart muscles to thicken, making it harder for blood to pump. The data also shows that cases are increasing. However, experts believe that the increase in diagnoses is due to increased awareness of commotio cordis that has better prepared people to treat it.
Published research shows that commotio cordis has been reported among players of many sports, including baseball, lacrosse, softball, martial arts, rugby union, soccer, cricket, and hockey. despite the use of protective equipment such as bibs or softer ballsalthough the risk is likely to be less with these precautions.
Still, it is considered an extremely rare event.
“I have been watching football all my life and I have never seen this happen. This is so unbelievably rare, it’s like winning Powerball or being struck by lightning twice,” said Dr. Grant Simons, a cardiac electrophysiologist and chief of cardiac rhythm services at Hackensack University Medical Center, who viewed the Buffalo Bills game live. “There is about a thirtieth of a second in which the heart is even vulnerable to this. Therefore, the blow must not only be in the right place on the heart and with the right amount of force, but it must also be perfectly timed.
The most recent study published by the US National Sudden Death Registry in Athletes in 2016 found that of 2,192 deaths, 58 athletes experienced commotio cordis between 1980 and 2011. The event is reported up to 20 times a yearmainly in the USA but in other countries also.
The last high-profile case involved hockey player Chris Pronger, when a puck struck him on the left side of his chest during the 1998 Stanley Cup Playoffs, knocking him out for about 20 seconds. Pronger returned to the ice four days later.
“Prayers that Damar Hamlin can have the same result that I was lucky to have with my incident”Pronger tweeted on January 3. “Our thoughts and prayers are with Damar, his family, his teammates and the greater NFL community during this incredibly scary time.”
How is commotio cordis treated?
Immediate treatment with CPR and an automated external defibrillator (AED) that delivers electrical shocks to the heart to restore its normal rhythm is absolutely necessary for survival after commotio cordis. Survival rates drop 10% for every minute of delay in being electrocuted by a DEA, according to the Korey Stringer Institute at the University of Connecticut.
Data from a national commotio cordis registry show that survival rates have been increasing in the last 15 years, reaching almost 60%. The researchers say that increased access to AEDs and better resuscitation training have helped improve survival rates.
Unfortunately, not all people who are resuscitated after a commotio cordis make a full recovery; some are left with brain injuries if treatment is not started quickly enough.
“Hopefully, they electrocuted him in a short amount of time and were able to do effective compressions to keep his brain supplied with oxygen,” Simons said. “If both of those things are true, then one would expect and hope that he would have a full neurological recovery and also a full cardiac recovery and not have any long-term functional effects on part of his brain.”