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Commotio Cordis Leads to Sudden Cardiac Arrest

Occurs from ill-timed blow to chest


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. (1)
  • accounts for 20% of sudden cardiac death in young athletes, exceeded only by hypertrophic cardiomyopathy (HCM) (25%) and ahead of congenital coronary artery abnormalities (14%).(2)  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. (3)
  • 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. (1)
  • 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, (5) although there have been no reports of an athlete wearing one brand of chest protector (Evoshield) suffering commotio cordis. Based on studies showing that softer baseballs meeting specifications set by the National Operating Committee on Standard for Athletic Equipment (level 1, 2, 3), reduce the risk of commotio cordis, their use was recently endorsed by the American Academy of Pediatrics. (4)
  • Emergency preparedness (establishment of an Emergency Action Plan, or EAP) is the key to survival once sudden cardiac arrest has occurred. (1) Has a survival rate that declines by approximately 7 to 10% for every additional minute that passes without defibrillation. After 12 minutes, the time Emergency Medical Service (EMS) paramedics typically arrive, it is usually too late (the national survival rate from sudden cardiac arrest (SCA) is a dismal 5%. In some cities it is as low as 1 to 2%.
  • Requires community-based programs using Automated External Defibrillators (AEDs) if the survival rate is to be increased. (1) When defibrillation is delivered in one minute, the reported survival rates can be as high as 90%. For defibrillation within 5 minutes, the survival rate can be as high as 50%. Of ten athletes who experienced commotio cordis from being struck by a lacrosse ball (8) or stick (2), timely defibrillation was performed on 7, with 4 surviving. (3)

To prevent deaths from commotio cordis it is necessary to train coaches, bystanders and other sports personnel in the recognition of this event and timely response. Basic life support training and access to AEDs are crucial to achieving this goal. (1)

1. Maron, B, et. al. Sudden Death in young competitive athletes: analysis of 1,866 deaths in the U.S 1980-2006. Circulation 2009; 119(8): 1085-1092. 

2. Casa D, Guskiewicz K, et al. National Athletic Trainers' Association Position Statement: Preventing Sudden Death in Sports. J Athl Tr 2011;47(1):1-24. 

3. Maron, B., et. al. Commotio Cordis and the Epidemilogy of Sudden Death in Competitive Lacrosse. Pediatrics 2009;124 (3); 976-981.

4.  American Academy of Pediatrics, Council on Sports Medicine and Fitness, Policy Statement: Baseball and Softball. Pediatrics 2012;129(3):842-856. (doi: 10.1542/peds.2011-3593)(accessed February 26, 2012)

5. Weinstock, J. et. al. Failure of commercially available chest wall protectors to prevent sudden cardiac death induced by chest wall blows in an experimental model of commotio cordis" Pediatrics 2006; 117(4).

Revised and updated May 31, 2013