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Commotio cordis
Commotio cordis (Latin, "agitation / disruption of the heart") is a disruption of heart rhythm that occurs as a result of a blow to the area directly over the heart (the precordial region) at a critical instant during the cycle of a heartbeat. The resulting sudden rise in intracavitary pressure leads to disruption of normal heart electrical activity, followed instantly by ventricular fibrillation, complete disorganization of the heart's pumping function, and cardiac arrest. It is not caused by mechanical damage to the heart muscle or surrounding organs and is not the result of heart disease.
The incidence of commotio cordis in the United States is fewer than 20 cases per year. It often occurs in boys participating in sports, most commonly in baseball when a ball strikes a player in the chest. Its rareness arises because it can occur only upon impact within a window of about 40 milliseconds in the cardiac electrical cycle.
The condition has a 97% fatality rate if not treated within three minutes. If cardiopulmonary resuscitation (CPR) combined with the use of an automated external defibrillator is employed within three minutes of the impact, survival can be as high as 58 percent.
There are only 10–20 cases annually in the United States. These cases occur mostly in boys and young men (mean age 15), usually during sports participation. It occurs most frequently in baseball when the hardball strikes an unprotected chest, although there have been cases of commotio cordis in players using a chest protector. It is usually caused by a projectile, but can also be caused by a blow from another player's elbow or other body part. Being less developed, the thorax of an adolescent is likely more prone to this injury than a mature adult.
Over a period of assessment from 2006–2012, the survival rate was 58 percent, which was an improvement over the years 1993–2006 when only 34 percent of victims survived. This increase is likely due to prompt CPR, access to defibrillation, and higher public awareness of this phenomenon.
Due to ventricular fibrillation and resultant cessation of the cardiac output to vital organs, commotio cordis has a high fatality rate, indicated by two studies to be 72–75 percent, with survival decreasing substantially if effective resuscitation was not performed within three minutes of the impact event. In a United States timeline analysis, survival was only ten percent over the years 1970–1993, while during 1994–2012, survival improved to 34 percent. A 2009 paper reported that survival drops to 3% when resuscitation is delayed beyond 3 minutes.
Higher survival rates correlated with immediate resuscitation by using CPR and an on-site automated external defibrillator—the survival rate was forty percent if resuscitation was performed within three minutes of the impact injury, contrasted with only five percent survival if resuscitation was delayed to more than three minutes after the impact. During the early 21st century, survival rates continued to improve to 58 percent of cases.
Commotio cordis is a very rare event, but nonetheless it is often considered when an athlete presents with sudden cardiac death. Some of the sports which have a risk for this cause of trauma are baseball, American football, association football (soccer), ice hockey, polo, rugby football, cricket, softball, pelota, lacrosse, boxing, professional wrestling, hurling and martial arts (see Touch of Death). Children are especially vulnerable, possibly due to the mechanical properties of their thoracic skeleton. From 1996 to spring 2007, the US National Commotio Cordis Registry had 188 cases recorded, with about half occurring during organized sports. Almost all (96%) of the victims were male, the mean age of the victims during that period was 14.7 years, and fewer than one in five survived the incident.
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Commotio cordis
Commotio cordis (Latin, "agitation / disruption of the heart") is a disruption of heart rhythm that occurs as a result of a blow to the area directly over the heart (the precordial region) at a critical instant during the cycle of a heartbeat. The resulting sudden rise in intracavitary pressure leads to disruption of normal heart electrical activity, followed instantly by ventricular fibrillation, complete disorganization of the heart's pumping function, and cardiac arrest. It is not caused by mechanical damage to the heart muscle or surrounding organs and is not the result of heart disease.
The incidence of commotio cordis in the United States is fewer than 20 cases per year. It often occurs in boys participating in sports, most commonly in baseball when a ball strikes a player in the chest. Its rareness arises because it can occur only upon impact within a window of about 40 milliseconds in the cardiac electrical cycle.
The condition has a 97% fatality rate if not treated within three minutes. If cardiopulmonary resuscitation (CPR) combined with the use of an automated external defibrillator is employed within three minutes of the impact, survival can be as high as 58 percent.
There are only 10–20 cases annually in the United States. These cases occur mostly in boys and young men (mean age 15), usually during sports participation. It occurs most frequently in baseball when the hardball strikes an unprotected chest, although there have been cases of commotio cordis in players using a chest protector. It is usually caused by a projectile, but can also be caused by a blow from another player's elbow or other body part. Being less developed, the thorax of an adolescent is likely more prone to this injury than a mature adult.
Over a period of assessment from 2006–2012, the survival rate was 58 percent, which was an improvement over the years 1993–2006 when only 34 percent of victims survived. This increase is likely due to prompt CPR, access to defibrillation, and higher public awareness of this phenomenon.
Due to ventricular fibrillation and resultant cessation of the cardiac output to vital organs, commotio cordis has a high fatality rate, indicated by two studies to be 72–75 percent, with survival decreasing substantially if effective resuscitation was not performed within three minutes of the impact event. In a United States timeline analysis, survival was only ten percent over the years 1970–1993, while during 1994–2012, survival improved to 34 percent. A 2009 paper reported that survival drops to 3% when resuscitation is delayed beyond 3 minutes.
Higher survival rates correlated with immediate resuscitation by using CPR and an on-site automated external defibrillator—the survival rate was forty percent if resuscitation was performed within three minutes of the impact injury, contrasted with only five percent survival if resuscitation was delayed to more than three minutes after the impact. During the early 21st century, survival rates continued to improve to 58 percent of cases.
Commotio cordis is a very rare event, but nonetheless it is often considered when an athlete presents with sudden cardiac death. Some of the sports which have a risk for this cause of trauma are baseball, American football, association football (soccer), ice hockey, polo, rugby football, cricket, softball, pelota, lacrosse, boxing, professional wrestling, hurling and martial arts (see Touch of Death). Children are especially vulnerable, possibly due to the mechanical properties of their thoracic skeleton. From 1996 to spring 2007, the US National Commotio Cordis Registry had 188 cases recorded, with about half occurring during organized sports. Almost all (96%) of the victims were male, the mean age of the victims during that period was 14.7 years, and fewer than one in five survived the incident.