Health Insights

Understanding Commotio Cordis in Young Athletes 

Commotio cordis is a rare cardiac phenomenon that occurs when a sudden, nonpenetrating trauma to the chest wall, such as a direct blow from a projectile or blunt impact, interrupts the cardiac cycle, leading to ventricular fibrillation and sudden cardiac arrest. Damar Hamlin, safety for the Buffalo Bills, famously suffered commotio cordis during a “Monday Night Football” NFL game on national TV.

Our team at UC Health was able to save his life by immediately beginning CPR and using a defibrillator for a prompt and effective response. The average age of young athletes who experience commotio cordis is around 15 years, and the condition is more prevalent in young males. In many cases, commotio cordis results in sudden cardiac death, making it the second most common cause of sudden death in young athletes, after hypertrophic cardiomyopathy.

The Cardiac Cycle and Ventricular Fibrillation

The cardiac cycle involves the coordinated contraction and relaxation of the heart muscles, ensuring the efficient pumping of blood throughout the body. Ventricular fibrillation is a life-threatening condition where the heart's lower chambers quiver instead of pumping blood. In commotio cordis, a sudden blow to the chest can interrupt the cardiac cycle, leading to ventricular fibrillation and the potential for sudden cardiac arrest.

Sports Equipment and the Risk of Commotio Cordis

The most common projectiles responsible for commotio cordis are baseballs, hockey pucks, and lacrosse balls. However, other sports, such as football, martial arts and soccer, have also reported cases. Even soccer balls can cause this rare condition when struck with enough force within the vulnerable period of the cardiac cycle. Governing bodies of various sports activities have sought to minimize the occurrence of commotio cordis by introducing safety balls, wearing protective gear, including chest protectors, and promoting awareness among coaches, athletes, and medical personnel.

The Importance of Prompt Medical Intervention

Despite the use of protective equipment, such as chest protection and chest leading, commotio cordis can still occur. The effectiveness of chest protectors varies, and in some instances, reported cases occurred even when the athletes were wearing protective gear. The key to increasing the survival rate of commotio cordis victims is prompt cardiopulmonary resuscitation (CPR) and the use of an automated external defibrillator (AED) to restore normal heart rhythm.

When a case of commotio cordis is suspected, a thorough cardiac evaluation should be conducted. This may involve tests such as ambulatory Holter monitoring to detect irregular heart rhythm, differential diagnosis to rule out other conditions like arrhythmogenic right ventricular dysplasia, Brugada syndrome, and Long QT syndrome. In some instances, an implantable cardioverter defibrillator may be recommended for individuals at high risk of sudden arrhythmic death.

Education and Awareness: The Key to a Safer Sports Environment

Education and awareness are vital in addressing commotio cordis. Athletes, coaches, and parents should be trained in CPR and AED use, as a few seconds can make the difference between life and death. Sports health organizations should also ensure that automatic external defibrillators are readily available at all sports venues.

What's next?

Commotio cordis is a rare but potentially fatal condition that can affect athletes across various sports. While protective measures like chest protectors and safety balls can help reduce the risk, they do not guarantee complete prevention. The most crucial factor in improving the outcome for commotio cordis survivors is prompt and appropriate medical intervention, including CPR and the use of an AED. By raising awareness and promoting education, the sports community can work together to create a safer environment for all athletes.

Additional UC Health Resources:

• Know the Signs, Help Save a Life: Sudden Cardiac Arrest vs. Heart Attack
• CPR Explained: How it Works, Why It’s Important and How to Get Trained

Ready to learn CPR?

• TAKE10 Cincinnati, powered by UC Health, is a free, 10-minute training designed to educate the community about compression-only CPR, an easy-to-learn technique that can save lives. TAKE10 is compression-only, so there is no mouth-to-mouth. Schedule a training here: https://www.take10cincinnati.com/

Already trained in CPR?

• If so, join PulsePoint Respond, an app that alerts users when someone nearby is having a cardiac arrest or in need of CPR. For more information, visit https://www.pulsepoint.org/. 

Frequently Asked Questions about Commotio Cordis

1. Can you play sports after commotio cordis? 
   • Yes, athletes can potentially return to playing sports after commotio cordis, but only after a thorough evaluation by a medical professional and a full recovery.
2. How many athletes suffer from commotio cordis? 
   • The exact number of athletes suffering from commotio cordis is difficult to determine, but it is considered a rare event. It is estimated to occur in 1 in 50,000 to 1 in 100,000 athletes.
3. How common is commotio cordis in sports? 
   • Commotio cordis is rare in sports but is more common in activities that involve projectiles, such as baseball, hockey, and lacrosse.
4. What Soccer player had commotio cordis?
   • There has been a soccer player who experienced commotio cordis. Christen Eriksen, a Danish midfielder, collapsed on the field during a game in June 2021 due to commotio cordis. 
5. Has anyone survived commotio cordis? 
   • Yes, some individuals have survived commotio cordis, particularly when immediate medical attention and CPR were provided.
6. Can commotio cordis be reversed? 
   • Commotio cordis can be reversed if prompt medical intervention, including CPR and defibrillation, is administered.
7. What are the odds of surviving commotio cordis? 
   • Survival rates for commotio cordis are low, but they can increase significantly with immediate CPR and defibrillation.
8. Do chest protectors prevent commotio cordis? 
   • Chest protectors can help reduce the risk of commotio cordis, but they do not guarantee complete prevention.
9. What does commotio cordis feel like? 
   • As commotio cordis often results in sudden cardiac arrest, affected individuals may lose consciousness, experience chest pain, or have difficulty breathing.
10. What most typically causes commotio cordis? 
    • Commotio cordis is typically caused by a sudden, forceful blow to the chest, often from a projectile like a baseball or hockey puck, during a critical point in the heart's electrical cycle.
11. How do you stop commotio cordis? 
    • Commotio cordis can be minimized by using protective gear, proper coaching, and encouraging a safe sports environment.
12. How do you fix commotio cordis? 
    • Immediate CPR and defibrillation are crucial for increasing the chances of survival and recovery from commotio cordis.
13. Can you make a full recovery after commotio cordis? 
    • Full recovery is possible after commotio cordis, but it depends on the promptness of medical intervention and the severity of the injury.
14. Do people fully recover from commotio cordis? 
    • Some individuals may fully recover from commotio cordis with prompt medical intervention, but outcomes can vary.
15. How fast does commotio cordis happen?
    • Commotio cordis happens almost instantly after a forceful blow to the chest during a vulnerable phase of the heart's electrical cycle.
16. What is the difference between commotio cordis and contusio cordis? 
    • Commotio cordis is a disruption of the heart's rhythm due to a blunt, non-penetrating blow, while contusio cordis is a direct injury to the heart muscle caused by a forceful impact.
17. Does commotio cordis cause permanent damage to the heart? 
    • Permanent damage to the heart from commotio cordis is possible but depends on the severity of the injury and the timeliness of medical intervention.
18. Is commotio cordis shockable? 
    • Yes, commotio cordis often results in ventricular fibrillation, a shockable rhythm that can be treated with defibrillation.