Commotio Cordis - We need to be prepared

Commotio Cordis (Cardiac Concussion) can be a cause of sudden death in young athletes. It is the result of a blunt force impact to the chest directly over the heart that occurs between heart contractions. The blunt force causes a lethal abnormal heart rhythm. Such impacts have been reported from projectiles such as baseballs, softballs, lacrosse balls, pucks, and even a fist. The injured player does not have a pre-existing heart disease and there is no structural damage to the heart, chest cavity, or chest wall from the impact.

Fortunately, Commotio Cordis is a rare event. According to the U.S. Commotio Cordis Registry, since 1998,130 athletes have died from blunt force injury to the heart. Of those, 70 were children 4-18, according to the Heart Center at TUFTS New England Medical Center. With an estimated 19 million children playing baseball alone, the rarity is easily seen. However, Commotio Cordis has been associated with a death rate of 90%.

•The National Athletic Trainers’ Association (NATA) has made the following suggestions to help prevent Commotio Cordis and keep athletes safe.

•Encourage all coaches and officials to become trained in CPR, automatic external defibrillator (AED) use, and first aid.

•Establish an emergency action plan (NATA’s Position Statement on Emergency Planning in Athletics – www.nata.org/publicinformation/files/emergencyplanningpdf - can be used to help set this up.

•Use sports chest protectors during practices and games. (Further research is needed in this area to assess effectiveness and to make improvements.)

•Ensure all protective equipment fits properly and is used as intended by the manufacturer.

•Maintain an even and clean playing surface.

•Teach athletes how to protect themselves against chest injuries. For example, in baseball or softball, coaching batters in ball avoidance. Batters should learn to turn away from an inside pitch and not open chest to the impact. Pitchers should also be coached in proper fielding positions and ball avoidance when necessary.

In conclusion, Commotio Cordis is a risk for all sports in which a projectile can strike the chest of an athlete. As stated above, this is a rare event, but athletes, coaches, parents, and emergency personnel need to be aware that it can happen. A good emergency action plan, appropriately trained personnel (such as certified athletic trainers), and an AED at all athletic venues can help reduce the risk associated with this rare injury.

References: Official Statement from the National Athletic Trainers’ Association on Commotio Cordis. May 2004. http://www.nata.org.; What is Commotio Cordis in Baseball? USA Baseball Medical/Safety Advisory Committee. March 2003. http://www.usabaseball.com/commotio_cordis.html.

About the Author: Darin Pranzoni, PT, ATC is the Sports Medicine Coordinator for Wuesthoff Rehabilitation Services in Rockledge, FL.