Ask An Expert: What Is Commotio Cordis?

With Chief of Cardiothoracic Surgery at Sarasota Memorial Hospital Jeffrey Sell, MD

With the dramatic collapse of Buffalo Bills’ safety Damar Hamlin on live television, a new and seemingly scary cardiac phenomenon entered the public lexicon—commotio cordis. Proposed by health professionals early on as a potential reason for the young and apparently healthy athlete to experience a near-fatal cardiac arrest on the field, the idea that sudden impact to the chest could cause the heart to stop just as suddenly took many by surprise and left parents wondering about the safety of their child’s athletic activities. We spoke to Sarasota Memorial Hospital’s chief of cardiothoracic surgery, Dr. Jeffrey Sell, to learn more.

What is commotio cordis?

Commotio cordis comes from the Latin, meaning “confusion of the heart” or “commotion of the heart.” If someone takes a blow to the chest at just the exact right moment of the cycle of the heart, it will depolarize, and will electrically stop the heart. And most of the time when the heart comes back, it requires a shock to get back in rhythm.

This has become a well-known problem in a lot of sports and it's very important for parents to know about it. I came here from Baltimore, where lacrosse was king, and the lacrosse balls are very hard. And they're prepared at almost all games to defibrillate. Because it can happen. And parents in that area know it can happen. It has happened in hockey. It can happen in martial arts.

All it takes is a blow to the chest, but it has to happen at exactly the right moment in the heart's cycle for the heart to go electrically silent and then come back in one of these bad rhythms.

Is this a common injury?

It's fairly uncommon and it is much more recognized now. In the past, people who had this injury had a very high mortality rate. It's much better now because people recognize it, know that it has to be treated with a shock delivery and are prepared, so it's a much better outlook now.

Is this something that parents should be more concerned about?

People are going to get hit in the chest all the time. It takes a precise hit at the exact moment to cause the problem. The important thing to know is that if someone goes down after getting hit in the chest, you have to be prepared to deliver a shock and have a defibrillator available.

Is this problem related to any previous heart conditions?

This problem is not related to any kind of abnormality of the heart. It's related to the event, the injury.

Is this a career-ending situation for athletes or can they fully recover?

They can fully recover, and they can return to play. It really depends on their recovery from the event, and mostly it depends on their brain.

If a patient comes in having experienced this event and they've been resuscitated, what happens next?

Something that’s called “advanced cardiac life support.”

If the brain spends a period of time without oxygen, then the brain cells can become damaged and die. So when people come in after an injury that has required resuscitation, we often cool their body temperature down a few degrees centigrade, and that allows the brain to recover in many circumstances. People that we thought before wouldn't wake up have come back and been absolutely fine.

What does recovery look like after the cooling? How long is the follow-up?

It's usually several days in the hospital and then, depending on how their brain wakes up, it could be fairly rapid. If they have some injury to the brain, it may take more time.

What do these events tell you about the importance of learning CPR and how to use an AED?

I think everybody, whether you have a child who's an athlete or a parent who's older—everybody—should know the basics of CPR and should understand how to use an AED. I was at a restaurant last night and saw there was an AED right there on the wall with a big sign. It's pretty straightforward to use, but, if people can find a place that provides that training, you should definitely do that.

Written by Sarasota Memorial copywriter Philip Lederer, MA, who crafts a variety of external communications for the healthcare system. SMH’s in-house wordsmith, Lederer earned his Master’s degree in Public Administration and Political Philosophy from Morehead State University, Ky, and has high cholesterol.