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Chest Gear May Not Protect Young Athletes From Deadly Blows

CHICAGO – Commercial gear may not adequately protect young athletes against sudden death caused by a blow to the chest, researchers reported at the American Heart Association’s Scientific Sessions 2006.

Commotio cordis (a Latin word meaning “commotion of the heart”) is the term for a blunt, non-penetrating blow to the chest that triggers an irregular heartbeat called ventricular fibrillation. Such a blow can be caused by hard contact with another person as in football or hockey, or equipment such as balls, bats, hockey sticks, hockey pucks or other projectiles.

Ventricular fibrillation is a condition in which the heart’s electrical activity becomes disordered. The heart’s lower (pumping) chambers contract in a rapid, unsynchronized way and little or no blood is pumped from the heart. Collapse and sudden death follows unless medical help is provided immediately.

“The difference between a benign blow and commotio cordis is timing,” said Barry J. Maron, M.D., senior author of the study and director of the Hypertrophic Cardiomyopathy Center at the Minneapolis Heart Institute Foundation. “If the blow occurs directly over the heart at a particular time in the heart’s cycle, the results can be catastrophic.”

Maron established the National Commotio Cordis Registry at the Minneapolis Heart Institute Foundation in 1995 to track cases. He and colleagues used data from the registry to determine the likelihood of sudden death in athletes exposed to chest blows while wearing chest protectors.

Of the 182 cases recorded since 1995, 85 (47 percent) occurred during practice or competition in organized sports. In 33 of the 85 competitive athletes (39 percent), fatal chest blow events occurred despite the presence of potentially protective equipment. The average age of these athletes was 15 years.

The remaining 53 percent of recorded cases occurred during recreational sporting activities or in normal activities around the home.

The athletes affected by commotio cordis included 14 hockey players (two goalies), 10 football players, six lacrosse players (three goalies), and three baseball players (all catchers).

Incidents that led to players’ deaths included: 23 in which padding didn’t cover the chest at the time of the blows so that projectiles, sticks and body checks appeared to miss the protective barrier; and 10 in which projectiles directly struck the chest protector.

“These athletes wore standard, commercially available chest barriers, made of polymer foam covered by fabric or a hard shell, generally perceived to provide protection from the consequences of chest blows,” Maron said.

“To be fair to manufacturers, these products were never designed with commotio cordis in mind, and we don’t know at this point exactly how to design a product that would have specific protection from commotio cordis. I think the information is important from an educational stand point. Parents have a right to know all the risks of the athletic field in sports participation. In addition, education is important to recognize commotio cordis when it occurs, permitting prompt resuscitation and defibrillation to occur.”

He said the findings indicate that attention should be focused on chest protection to make the athletic field safer for youth sports participants.

“Hopefully, these data will represent a stimulus for developing a truly effective chest barrier that will be absolutely protective against the risk of these commotio cordis catastrophes,” Maron said.

Maron’s conclusions are supported by laboratory research. In an experimental model of commotio cordis developed at the New England Medical Center and Tufts University School of Medicine in Boston, ventricular fibrillation could be produced by a baseball moving 30 mph, but only if impact occurs directly over the heart during a 20 millisecond window when the lower heart chambers (ventricles) relax electrically, which may explain why events are rare, although tragic.

Co-authors are Joseph J. Doerer, B.A.; Tammy S. Haas, R.N.; Mark S. Link, M.D.; and Mark Estes III, M.D.

The study was funded by the National Operating Committee on Standards for Athletic Equipment (NOCSAE).

Statements and conclusions of study authors that are published in the American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect association policy or position. The American Heart Association makes no representation or warranty as to their accuracy or reliability.

For additional information, go to www.americanheart.org.

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American Heart Association press release.

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