Commotio Cordis Follow-up

  • Author: Steven M Yabek, MD, FAAP, FACC; Chief Editor: Stuart Berger, MD   more...
 
Updated: Mar 18, 2011
 

Deterrence/Prevention

The 36th Bethesda Conference on Eligibility Recommendations for Competitive Athletes with Cardiovascular Abnormalities had a number of recommendations regarding commotio cordis (CC).[8]

Children and adolescents aged 13 years and younger should use age-appropriate safety baseballs.

Although commercial chest wall protectors prevent traumatic injury in some instances, the construction of many products is not sufficient to prevent transmission of blows to the heart in all instances. In a recent review, 32% of commotio cordis events that occurred during competitive sports were in athletes wearing a chest protector.[5]

All sports venues should have immediate access (within 5 min) to an automated external defibrillator (AED).

Survivors of commotio cordis should undergo a thorough cardiac evaluation, including a 12-lead ECG, ambulatory Holter monitoring, and complete echocardiography.

Eligibility for returning to competitive sports following a commotio cordis episode is, at present, a decision left to individual clinical judgment. No evidence suggests that survivors of commotio cordis have a greater risk of future arrhythmic events.

Because risk is proportional to the hardness and compactness of the object that strikes the precordium, consideration may be given to the use of specially designed, softer-than-normal safety baseballs in recreational and Little League baseball.

Next

Prognosis

  • Survival from a commotio cordis event is the exception. Based on the most recent National Commotio Cordis Registry data, only 25% of individuals have survived a commotio cordis episode. Overall, survival trends following exercise-related sudden cardiac arrest from all causes in young athletes continues to be dissapointing.[9]
  • Despite greater awareness of sudden cardiac death in athletes and the increasing availability of AEDs at athletic venues, overall successful resuscitation and survival from 2000-2006 was only 11%. Most resuscitation failures have been attributed to delayed onset of cardiopulmonary resuscitation (CPR) and defibrillation. Survival has usually been associated with effective CPR efforts that are begun within 1 minute of the collapse. However, in a report of 9 witnessed and sudden cardiac arrests among intercollegiate athletes, only 1 survived, despite initiation of CPR within 1 minute in 8 of the 9 cases and defibrillation at an average of 3 minutes in 7 of 9 cases.[10] Two of the individuals had a commotio cordis event. In 6 cases, a cardiac abnormality was identified.
  • Failure of timely resuscitation efforts may relate to several factors, the most important of which is the presence of structural heart disease. In those with an anatomically normal heart suffering a commotio cordis event, the duration and intensity of exercise prior to arrest, higher than normal endogenous catecholamine levels and a decrease in systemic vascular resistance may all play a role in limiting the success of resuscitation.[10]
  • Standard chest compressions following electrical defibrillation may predispose to episodes of repeated refibrillation, thereby limiting the effectiveness of resuscitation. Despite the current AHA Guidelines, some studies have demonstrated that chest compressions result in electrical capture of the ventricles which, under certain conditions, can lead to so-called "long-short" electrical sequences that initiate fibrillation.[11]
Previous
 
Contributor Information and Disclosures
Author

Steven M Yabek, MD, FAAP, FACC  Pediatrix Cardiology Associates of New Mexico (a Division of Mednax Medical Group), Presbyterian Hospital Medical Center

Steven M Yabek, MD, FAAP, FACC is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, Heart Rhythm Society, New Mexico Pediatric Society, Society for Pediatric Research, and Western Society for Pediatric Research

Disclosure: Nothing to disclose.

Specialty Editor Board

Ira H Gessner, MD  Professor Emeritus, Pediatric Cardiology, University of Florida College of Medicine

Ira H Gessner, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Pediatric Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Hugh D Allen, MD  Professor, Department of Pediatrics, Division of Pediatric Cardiology and Department of Internal Medicine, Ohio State University College of Medicine

Hugh D Allen, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Pediatric Society, American Society of Echocardiography, Society for Pediatric Research, Society of Pediatric Echocardiography, and Western Society for Pediatric Research

Disclosure: Nothing to disclose.

Gilbert Z Herzberg, MD  Assistant Professor, Department of Pediatrics, Section of Pediatric Cardiology, New York Medical College; Consulting Staff, Department of Pediatrics, Sound Shore Medical Center

Gilbert Z Herzberg, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Chief Editor

Stuart Berger, MD  Professor of Pediatrics, Division of Cardiology, Medical College of Wisconsin; Chief of Pediatric Cardiology, Medical Director of Pediatric Heart Transplant Program, Medical Director of The Heart Center, Children's Hospital of Wisconsin

Stuart Berger, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American College of Chest Physicians, American Heart Association, and Society for Cardiac Angiography and Interventions

Disclosure: Nothing to disclose.

References

  1. Maron BJ. Sudden death in young athletes. N Engl J Med. Sep 11 2003;349(11):1064-75. [Medline].

  2. Link MS, Wang PJ, Pandian NG, et al. An experimental model of sudden death due to low-energy chest-wall impact (commotio cordis). N Engl J Med. Jun 18 1998;338(25):1805-11. [Medline].

  3. Maron, BJ: Clinical Features of Commotio Cordis. Presentation of Registry Data at Heart Rhythm Society Scientific Sessions [database online]. Boston, Massachusetts: May 15, 2009.

  4. Alsheikh-Ali AA, Madias C, Supran S, Link, MS. Marked Variability in Susceptibility to Ventricular Fibrillation in an Experimental Commotio Cordis Model. Circulation. Dec 14 2010;122 (24):2499 - 2504. [Full Text].

  5. Maron BJ, Estes III NAM. Commotio Cordis. New England Journal of Medicine. Mar 11 2010;362(10):917 - 26.

  6. Link MS, Maron BJ, Wang PJ, et al. Upper and lower limits of vulnerability to sudden arrhythmic death with chest-wall impact (commotio cordis). J Am Coll Cardiol. Jan 1 2003;41(1):99-104. [Medline].

  7. Amir O, Schliamser JE, Nemer S, Arie M. Ineffectiveness of precordial thump for cardioversion of malignant ventricular tachyarrhythmias. Pacing Clin Electrophysiol. Feb 2007;30(2):153-6. [Medline].

  8. Maron BJ, Estes NAM, Link MS. 36th Bethesda Conference: Eligibility recommendations for competitive athletes with cardiovascular abnormalities. Task Force 11: Commotio Cordis. J Am Coll Cardiol. Apr 19 2005;45(8):1371-3. [Medline].

  9. Drezner JA, Chun JS, Harmon KG, Derminer L. Survival trends in the United States following exercise-related sudden cardiac arrest in the youth: 2000-2006. Heart Rhythm. Jun 2008;5(6):794-9. [Medline].

  10. [Guideline] Drezner JA, Rogers KJ. Sudden cardiac arrest in intercollegiate athletes: detailed analysis and outcomes of resuscitation in nine cases. Heart Rhythm. Jul 2006;3(7):755-9. [Medline].

  11. Osoria J, Dosdall DJ, Robichaux Jr RP, Tabereaux PB, Ideker RE. In a Swine Model, Chest Compressions Cause Ventricular Capture and, By Means of a Long-Short Sequence, Ventricualar Fibrillation. Circ Arrhythmia Electrophysiol. 2008/10;1:282 - 9.

  12. Abrunzo TJ. Commotio cordis. The single, most common cause of traumatic death in youth baseball. Am J Dis Child. Nov 1991;145(11):1279-82. [Medline].

  13. Futterman LG, Lemberg L. Commotio cordis: sudden cardiac death in athletes. Am J Crit Care. Jul 1999;8(4):270-2. [Medline].

  14. Link MS, Bir C, Dau N, Madias C, Estes NA 3rd, Maron BJ. Protecting our children from the consequences of chest blows on the playing field: a time for science over marketing. Pediatrics. Aug 2008;122(2):437-9. [Medline].

  15. Link MS, Estes NA 3rd. Mechanically induced ventricular fibrillation (commotio cordis). Heart Rhythm. Apr 2007;4(4):529-32. [Medline].

  16. Link MS, Ginsburg SH, Wang PJ, et al. Commotio cordis: cardiovascular manifestations of a rare survivor. Chest. Jul 1998;114(1):326-8. [Medline].

  17. Link MS, Maron BJ, VanderBrink BA, et al. Impact directly over the cardiac silhouette is necessary to produce ventricular fibrillation in an experimental model of commotio cordis. J Am Coll Cardiol. Feb 2001;37(2):649-54. [Medline].

  18. Link MS, Wang PJ, VanderBrink BA, et al. Selective activation of the K(+)(ATP) channel is a mechanism by which sudden death is produced by low-energy chest-wall impact (Commotio cordis). Circulation. Jul 27 1999;100(4):413-8. [Medline].

  19. Maron BJ, Gohman TE, Kyle SB. Clinical profile and spectrum of commotio cordis. JAMA. Mar 6 2002;287(9):1142-6. [Medline].

  20. Maron BJ, Link MS, Wang PJ, Estes NA 3rd. Clinical profile of commotio cordis: an under appreciated cause of sudden death in the young during sports and other activities. J Cardiovasc Electrophysiol. Jan 1999;10(1):114-20. [Medline].

  21. Maron BJ, Strasburger JF, Kugler JD, et al. Survival following blunt chest impact-induced cardiac arrest during sports activities in young athletes. Am J Cardiol. Mar 15 1997;79(6):840-1. [Medline].

  22. Vincent GM, McPeak H. Commotio cordis: a deadly consequence of chest trauma. Phys Sportsmed. Nov 2000;28(11):31-9. [Medline]. [Full Text].

 
Previous
Next
 
Relationship of the anatomy of the human thorax to the internal viscera (heart and lungs) and bones (sternum and ribs).
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.