Commotio cordis: NFL player’s collapse spotlights rare heart phenomenon

Mark Link, M.D. Internal Medicine – Cardiology Seeing NFL player Damar Hamlin collapse and go into cardiac arrest on “Monday Night Football” was frightening for the millions of people watching around the world – especially for parents of young athletes. Mr. Hamlin, a 24-year-old Buffalo Bills safety, dropped to the ground after making a tackle Jan. 2 in the Cincinnati Bengals game. Thanks to swift action from first responders and trainers on the field, Mr. Hamlin’s heartbeat was restored using CPR and an automated external defibrillator (AED), and he was rushed to a nearby hospital for intensive care. While we don’t yet know exactly what caused Mr. Hamlin’s cardiac arrest, the incident has shined a light on a rare heart trauma called commotio cordis – when a healthy heart is stopped suddenly by a blow to the chest that lands in between heartbeats.

Reported cases of commotio cordis range from 15 to 20 per year in the U.S., but they are always shocking because they typically involve healthy young athletes – the average age is 14.Mark Link, M.D.

Latin for “agitation of the heart,” commotio cordis requires a perfect storm of sorts: The timing, location, and impact of the blow all must line up to send the heart into ventricular fibrillation, which is an uncoordinated quiver that can cause cardiac arrest. Reported cases of commotio cordis range from 15 to 20 per year in the U.S. but are always shocking because they typically involve healthy young athletes – the average age is 14. The majority of commotio cordis incidents have been reported in baseball or softball, followed by hockey, lacrosse, and football. We understand parents might be concerned about their children’s safety following the Damar Hamlin incident, but the truth is young athletes are more at risk of injury driving to and from practice than they are of suffering commotio cordis. Numerous studies have shown that sports can play a significant role in the physical and emotional development of a child, so it’s important to keep the risk of commotio cordis in perspective while also taking precautions, such as wearing protective gear that has been developed in recent years to guard against this rare occurrence.

Know how to do CPR – and find an AED

If there’s a silver lining to Mr. Hamlin’s ordeal, it is the increased focus on the value of learning CPR and having public access to AEDs – both of which are critical in the moments immediately following sudden cardiac arrest. Mr. Hamlin was fortunate to be surrounded by fast-acting first responders, and he continues to recover from his injuries. About half of the people who suffer commotio cordis die from it. Performing hands-only CPR and using an AED provide the best chance of survival. Brain cells start to die about five minutes after blood flow stops. Once brain cells are dead, they won’t come back. CPR can keep the blood flowing in the body even when the heart has stopped, providing crucial blood flow to the brain. Anyone can do CPR. It requires only a few steps, and you can learn it in just a couple minutes. Since 2013, all Texas high school students have been required to take CPR training to graduate. More than 40 U.S. states require CPR training for high schoolers. This is important because performing CPR can be lifesaving, and it often requires a team effort. Most people have the endurance to do CPR well for only a few minutes, which is why the American Heart Association recommends taking turns to keep CPR going strong. An athlete who has commotio cordis may stumble forward for a few seconds and collapse after being hit in the chest, followed by unconsciousness, no breathing, and no pulse. If that happens, direct someone to call 911 and someone else to grab the nearest AED, then start CPR immediately. An AED is a device that can analyze the heart’s rhythm and, if necessary, deliver an electrical shock to help the heart re-establish an effective rhythm. Using an AED may sound intimidating, but the devices are simple to operate and include audio instructions and images to help you properly place the pads on the unconscious person’s chest. The number of AEDs found in public spaces has increased dramatically over the years. Texas school districts are required to make an AED available at each campus and during any athletic competition, athletic practice, or large student gathering. However, AEDs are only useful if people know where they are. AEDs should be visible, not locked up, and not far from the field of action. Parents and students can take a proactive role by identifying where the nearest AED is located prior to a game. If there isn’t one, ask why.

Make sure athletes wear required chest protectors

About 95% of cases of commotio cordis occur in male teens, with a significant drop-off at age 20. That’s likely due to a hardening of the chest wall as people get older, and because we tend to play fewer contact sports with projectiles traveling at high speeds as we age. But there are additional precautions teens can take to protect themselves from this rare cardiac phenomenon. I’ve been active in commotio cordis research for nearly 30 years, and one area in which we’ve made great strides is in developing more effective chest protectors for baseball catchers, as well as hockey and lacrosse athletes. Although such gear may not be able to totally prevent commotio cordis, it provides an added safeguard from the impact of a ball striking the chest right over the heart. The National Operating Committee on Standards for Athletic Equipment (NOCSAE), an organization that develops standards for athletic equipment such as football helmets, developed new standards for chest protectors in 2017 to protect against commotio cordis. These standards were based on a mechanical model my research colleagues and I developed to assess the impact of blows to the heart. Whether chest protectors are required varies depending on each sport’s governing body. While we don’t have a high volume of data to show how effective chest protectors are in protecting against commotio cordis because the condition is so uncommon, young athletes playing baseball, hockey, or lacrosse may want to consider them. As with any protective equipment, make sure your child’s chest protector fits properly and check the label to ensure it meets NOCSAE standards. Commotio cordis is a rare, unpredictable, and potentially tragic event. The best way to save an athlete from sudden cardiac arrest on the playing field is to make sure that all coaches and players know CPR and have quick access to AEDs. Take a moment to watch this hands-only CPR video from the American Heart Association. It provides the knowledge to potentially save a life.