Commotio Cordis

Commotio Cordis

Commotio Cordis refers to the sudden arrhythmic death caused by a low/mild chest wall impact. Commotio Cordis is seen mostly in athletes between the ages of 8 and 18 who are partaking in sports with projectiles such as baseballs, hockey pucks, or lacrosse balls.

These projectiles can strike the athletes in the middle of the chest with a low impact but enough to cause the heart to enter an arrhythmia.

Martial arts is a sport in which a strike of a elbow, hand, foot or knee can also cause the heart to change it’s rhythm.

Without immediate CPR and defibrillation the prognosis of commotio cordis is not very good.

This condition is extremely dangerous with rare survival.

HOW DO YOU PREVENT COMMOTIO CORDIS?​

• Have an athletic trainer present at practices and games

• Educate coaches, parents, and athletes how to perform CPR and use an AED

• Educate coaches, parents, and athletes of signs of commotio cordis

• Have an AED accessible near ringside at all times

• Ensure coaches know where to locate the AED

• Ensure there is an Emergency Action Plan in place

• Ensure protective equipment is properly fitted

• Teach athletes how to avoid being struck to the heart

• Avoid strength disparities among participants and coaches

LOOK FOR THESE SYMPTOMS IN FIGHTERS IF COMMOTIO CORDIS IS SUSPECTED:​

• Look for a fighter who was hit in the chest before collapsing

• There should be no apparent trauma

• The fighter will typically stumble forward for a few seconds, which is followed by unconsciousness, no breathing, and no pulse

• An AED will indicate the athlete is in ventricular fibrillation

• Factors leading to commotio cordis include:

“Timing of Impact” refers to the timing of the object hitting the chest during the cardiac cycle.  The heart is most vulnerable when it is struck at the beginning of the T-wave.  This part of the cycle indicates the refilling of the heart’s ventricles.

​WHAT ELSE COULD THIS BE?

This condition could be confused with the following conditions due to similar presentation:

• Cardiac Arrest

• Pulmonary Conditions

• Hypertrophic Cardiomyopathy

• Concussion

• Heat Syncope

​HOW DO YOU TREAT AN INDIVIDUAL WITH COMMOTIO CORDIS?​

• Use an AED and defibrillator as quickly as possible.

• For every 1 minute delay in getting shocked by the AED there
  is a 10% decline in survival rate.

• Using an AED is the best practice and gives the fighter the greatest chance of survival.

• Immediately activate EMS and the events Emergency Action Plan.

• Continue AED use and CPR until EMS arrives and takes over.

​WHEN CAN THE INDIVIDUAL RETURN TO ACTIVITY?​

• Before returning to play that fighter should have a cardiac evaluation including ECG by the fighter’s physician.

• Physician clearance is necessary before returning to training.

• The fighter’s trainer should use clinical judgement during return to training and should carefully watch the fighter to ensure a cardiac episode does not occur.

• Adjust practice by adding personal protection such as chest padding  to decrease the chance of another incident.