Commotio Cordis: A Rare Phenomenon in Sports

Feb 14, 2023

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By Clinical Education/Professional Development Melanie Burnett, MSN, RN and Interim ICU Nurse Manager Tiffany Jellings, BSN, RN

In commemorating February’s American Heart Month, William Newton Hospital would like to use this chance to educate the community on what seems to be a little-known phenomenon in sports.

Commotio cordis is a rare cause of cardiac arrest from blunt chest trauma and is the second most common cause of death in athletes. It is more common in male athletes than in females. There are approximately 30 cases reported every year in the United States. Commotio cordis is usually only diagnosed after excluding other health issues for the cause of cardiac arrest. It is most commonly found in young athletes with no prior cardiac issues with the mean age being 15 years old. Often the cause of commotio cordis is small hard objects like baseballs, hockey pucks, or softballs hitting the anterior part of the chest overlying the heart at high speeds, which can even occur with protective equipment designed to cover the chest.

The blow to the chest has to be timed just right, a 10-to-30-millisecond window in the cardiac cycle, to reset the internal pacemaker of the heart into ventricular fibrillation. It is for this reason commotio cordis is considered such a rare phenomenon.

The best way to treat commotio cordis is to have an automatic external defibrillator, also known as an AED, ready for use at all arenas and practices. If an AED is not available, performing CPR as soon as the event occurs is acceptable, and then notifying emergency medical services by calling 911. Starting one of these treatments as soon as possible improves the athlete’s chance of survival significantly.

How to prepare for this rare cardiac event

1. Be properly trained on how to use and operate an AED machine
2. Have coaches and players take CPR classes
3. Be able to recognize the event itself
4. Make sure all players wear the appropriate protective gear

Myth vs. Fact

Myth: Screening athletes for sudden cardiac death (SCD) can fix the issue at hand.

• Fact: Although screening might help, there have been no studies that would make a 100% effective way to make a difference in the diagnosis of commotio cordis, according to an article titled Risk Factors for Sudden Death in Athletes by Hajduczok, Ruge and Emery (2022).

Myth: The survival rate of commotio cordis is low.

• Fact: The rate at which people survive this cardiac event is actually increasing, as many witnessed NFL football player Damar Hamlin on the night of his event. This is due to quicker response time, the availability of AED machines, and the public being more aware of the phenomenon.

This is just a small part of the education that the William Newton Healthcare Foundation’s Beats Go On community wellness initiative is addressing. Project Adam addresses another cardiac arrest phenomenon known as Sudden Cardiac Arrest or SCA. William Newton Hospital is currently working with Winfield High School and will be working with other area high schools and businesses in the near future for these educational opportunities.

Visit Beats Go On to learn more

This article was submitted for the "Weekend Check-Up," a regular health column in the Cowley CourierTraveler penned by employees and friends of William Newton Hospital.