Hamlin’s life was saved by the prompt action of the sports medicine team and first responders who administered CPR and used an automated external defibrillator (AED).
Commotio cordis, meaning "agitation of the heart" in Latin, accounts for approximately 20% of sudden cardiac deaths in young athletes.
The condition can occur outside sports, in incidents like motor vehicle accidents or assaults, but is most commonly associated with athletic activities.
The pathophysiology of commotio cordis involves a high-velocity impact to the precordium, leading to disturbances in cardiac rhythm without structural heart damage. The most common arrhythmias induced by such impacts are ventricular fibrillation and asystole.
Several factors increase the likelihood of commotio cordis: the size and force of the impacting projectile, the impact site being directly over the precordium, and the timing of the impact in relation to the cardiac cycle.
Risk factors include chest wall weakness, with young male baseball players being the most common victims, and racial disparities, as black athletes are at higher risk than white athletes.
Prevention and emergency response are key in managing commotio cordis. Athletic teams often perform cardiac screenings to identify conditions like hypertrophic cardiomyopathy; however, there is currently no way to screen for commotio cordis.
Preparedness and rapid emergency response are crucial. NATA recommends that all organizations sponsoring athletic competitions develop and implement written emergency action plans for their facilities.
Chest protectors and safety baseballs have been thought to reduce the risk of commotio cordis, with some studies suggesting a significant reduction in risk with their use. However, the effectiveness of commercially available chest protectors is still under evaluation.
The survival rates for commotio cordis are improving, thanks in part to increased awareness and education. The decision for an athlete to return to sports after surviving commotio cordis should be made by a medical team, including various specialists.
While commotio cordis is a rare event, its potential severity requires continuous education, emergency preparedness, and proper training in CPR/AED use among medical professionals, coaches, and officials to help prevent related deaths.
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