Commotio Cordis: Can A Chest Protector Help?

Commotio cordis is the medical term for a rare disruption of the heart's electrical system resulting from a blunt impact to the chest that leads to sudden cardiac arrest.

Commotio cordis:

• Has been documented in over 250 cases since the formation of the United States Commotio Cordis Registry in Minneapolis, Minnesota in 1998, although the true number of deaths is unknown because of underreporting and misclassification.
• Is one of the leading cause of sudden cardiac death in young athletes, exceeded only by hypertrophic cardiomyopathy and congenital coronary artery abnormalities.  It is the second highest cause of death in athletes younger than 14 years, and is unique occurrence among children, usually younger than 16 years;
• The commotio cordis sudden-death rate is highest in lacrosse (.63 deaths per 100,000 person-years), hockey (.53 deaths per 100,000 person-years) and baseball (.24 deaths per 100,000 person-years), rates significantly higher than in other sports.
• Is largely the result, not of the force of the blow but from an incredibly untimely blow contacting the chest directly over the heart at just the wrong time -- the precise millisecond between heart contractions that throws the heart into a lethal abnormal heart rhythm called "ventricular fibrillation" or VF, which causes a useless quivering of the heart that results in a complete cessation of circulation instantly depriving the brain and other vital organs without circulation and oxygen. The blows usually causes no identifiable structural injury to the ribs, sternum or to the heart itself.
• Occurs most often in healthy young athletes, who are especially at risk because the pliability of their chest walls. In one study of 55 cases of sudden cardiac arrest, 90% were 16 years of age or younger, 25 were playing in organized athletic events such as baseball, softball, and ice hockey. The remaining 30 children were playing informal sports at home, school or on the playground. None of the children showed evidence of any heart defect or diseases. 
• Cannot be completely eliminated through the use of protective equipment. Commercially available chest protectors have not been shown in any peer-reviewed studies to prevent against commotio cordis for athletes playing baseball, lacrosse, hockey and softball, but whether such a heart shield provides an extra measure of protection is unknown.  There have been, however, no reports of an athlete wearing one brand of chest protector (Evoshield)* suffering commotio cordis.

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* In accordance with FTC disclosure rules, please note that Evoshield is a MomsTeam sponsor.

Posted February 29, 2012