Commotio cordis is a Latin term (meaning commotion or disturbance of the heart) that describes sudden cardiac arrest from a blow to the chest. While commotio cordis can happen to anyone, victims are overwhelmingly male and young. Despite the fact that it's very rare, commotio cordis is the leading cause of death in youth baseball. Commotio cordis has also been documented in hockey, lacrosse, karate and has happened at least once from a soccer ball.
How Commotio Cordis Happens
It doesn't take much force to trigger commotio cordis. It's all about timing. After squeezing blood out to the body, the heart resets for the next contraction. If something hits the chest right in front of the heart at just the right moment during that reset phase, the heart can suddenly begin quivering in a condition known as ventricular fibrillation, a cause of cardiac arrest. The victim will instantly pass out and stop breathing.
Researchers have induced commotio cordis fairly consistently by shooting baseballs at pigs timed to just the right moment. The optimum speed for a baseball to cause commotio cordis -- at least in unconscious pigs swinging from special slings -- is about 40 miles per hour, well within throwing speed for many young pitchers. That's just the optimum speed, however, not the only one. In one documented case of commotio cordis, a dad tossed a softball underhand to his 6-year-old at a picnic. The ball glanced off the boy's glove and hit him in the chest, causing cardiac arrest.
Commotio Cordis Treatment: Act Fast
Imagine you're a coach for a little league team. A 12-year-old batter steps up to the plate. The pitcher throws a fastball right down the strike zone. The batter swings and tips it just enough that the ball misses the catcher's glove and hits him in the chest. By the time the umpire yells "Foul!" the catcher is collapsing to the ground. What would you do?
Too often the response to a youth league athlete suddenly collapsing is confusion and hesitation. What should happen is immediate CPR and, if available, use of an automated external defibrillator (AED). Commotio cordis is the most compelling reason I can think of for coaches and parents to learn CPR and for youth sports fields to own defibrillators. Indeed, commotio cordis is a good reason for players to learn CPR also.
Acting quickly is the key. In 128 cases of commotio cordis documented before September 1, 2001, 25% of those treated immediately survived. Of those victims whose treatment was delayed for any length of time, 3% survived. Only saving 1 out of 4 victims isn't a great statistic, but it's much better than 3 out of a hundred. The good news is that those who survived usually had no brain damage.
Here's what should happen:
- See a kid collapse after getting hit in the chest
- Rush to the child and see if he's breathing
- Order the closest parent or coach to call 911
- Start CPR -- adult CPR if he's hit puberty or child CPR if not
- If you have an AED, order someone to get it immediately
If you are alone with the victim, do CPR right away for a minute and then call 911. Or, call 911 on your cell phone and push the speakerphone button, set it down and start CPR. You can talk and push on the chest at the same time. Any time wasted not pushing on the chest is brain damage happening.
Preventing Commotio Cordis
The only proven way to prevent commotio cordis is to eliminate bumps to the chest. Since most of these sports either require chest impact (karate) or there's simply no way to prevent it (baseball, hockey and lacrosse), the only option is to find ways to make the impacts less forceful.
Experts have suggested using chest protectors, but so far none of the commercially available chest protectors has been shown to work. Until somebody creates a model that actually protects kids, I don't think chest protectors are worth the money or the discomfort to the players.
Safety baseballs do seem to reduce the likelihood of commotio cordis in studies, although there are some documented cases involving softer baseballs marketed for safety causing commotio cordis. Personally, I think softer baseballs for the little kids makes sense, but the older kids will have to learn to play with regulation baseballs sooner or later.
In my opinion, preventing deaths from commotio cordis is all about responding quickly and appropriately if it happens. Don't let your kid play for a team or a league that doesn't require CPR training for all of its coaches. Take a CPR class yourself, and make sure you get AED training as well. Don't let the instructor gloss over the AED training, either. Becoming familiar with the tool is the best way to use it correctly when the time comes.
Commotio cordis is scary, but it is very rare. Don't let such an unlikely event keep you from encouraging your kids to be active and competitive. If you see commotio cordis happen, to your child or to anyone else's, act immediately and prevent it from taking even one more young life.
Abrunzo, T.J.. "Commotio cordis. The single, most common cause of traumatic death in youth baseball." Am J Dis Child. 1991 Nov;145(11):1279-82
Link, Mark S., et al."Reduced Risk of Sudden Death From Chest Wall Blows (Commotio Cordis) With Safety Baseballs ." Pediatrics. Vol. 109 No. 5 May 2002, pp. 873-877
Doerer, J.J., et al."Evaluation of chest barriers for protection against sudden death due to commotio cordis." Am J Cardiol. 2007 Mar 15;99(6):857-9
Maron, Barry, et al."Clinical Profile and Spectrum of Commotio Cordis." JAMA. 2002;287(9):1142-1146
Maron, Barry, et al."Survival following blunt chest impact-induced cardiac arrest during sports activities in young athletes." Am J Cardiol. 1997 Mar 15;79(6):840-1
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 Apr;117(4):e656-62