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. |