Commotio cordis: a case of ventricular fibrillation caused by a cricket ball strike to the chest
ABSTRACT A healthy 25-year-old man was attending cricket practice in March, 2012, when he was struck over the praecordium by a cricket ball while batting right-handed without a chest protector. He collapsed within 30 s of impact and was found unconscious by coaching staff trained in first aid. Cardiopulmonary resuscitation (CPR) was started and emergency services were called. Paramedics attended the scene 9 min after the injury. They found the patient to be in ventricular fibrillation (appendix) and immediately delivered a 200 J biphasic shock, resulting in return of spontaneous circulation and sinus rhythm.
Article: Commotio cordis.New England Journal of Medicine 03/2010; 362(10):917-27. DOI:10.1056/NEJMra0910111 · 54.42 Impact Factor
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ABSTRACT: BACKGROUND: Commotio cordis events due to precordial blows triggering ventricular fibrillation are a cause of sudden death (SD) during sports, and also daily activities. Despite absence of structural cardiac abnormalities, these events have been considered predominantly fatal with low survival rates. OBJECTIVES: To determine whether expected mortality rates for commotio cordis have changed over time, associated with greater public visibility. METHODS: U.S. Commotio Cordis Registry was accessed to tabulate frequency of reported SD or resuscitated cardiac arrest over 4 decades. RESULTS: At their commotio cordis event, 216 study patients were 0.2 to 51 years old, mean 15; 95% were male. Death occurred in 156 individuals (72%), while the other 60 (28%) survived. Proportion of survivors increased steadily with concomitant decrease in fatal events. For the initial years (1970-1993), 6 of 59 cases survived (10%) while during 1994-2012, 54/157 (34%) survived (p = 0.001). The most recent 6 years, survival from commotio cordis was 31/53 (58%), with survivor and non-survivor curves ultimately crossing. Higher survival rates were associated with more prompt resuscitation (40% < 3 minutes vs. 5% > 3 minutes; p < 0.001) and participation in competitive sports (39%; p < 0.001), but with lower rates in African-Americans (1/24; 4%) compared to whites (54/166; 33%; p = 0.004). Independent predictors of mortality were black race (p = 0.045), and participation in non-competitive sports (p = 0.002), with onsite AED use protective against SD (p = 0.01). CONCLUSIONS: Survival from commotio cordis has increased, likely due to more rapid response times and access to defibrillation, as well as greater public awareness of this condition.Heart rhythm: the official journal of the Heart Rhythm Society 10/2012; 10(2). DOI:10.1016/j.hrthm.2012.10.034 · 4.92 Impact Factor
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ABSTRACT: The syndrome of sudden death due to low-energy trauma to the chest wall (commotio cordis) has been described in young sports participants, but the mechanism is unknown. We developed a swine model of commotio cordis in which a low-energy impact to the chest wall was produced by a wooden object the size and weight of a regulation baseball. This projectile was thrust at a velocity of 30 miles per hour and was timed to the cardiac cycle. We first studied 18 young pigs, 6 subjected to multiple chest impacts and 12 to single impacts. Of the 10 impacts occurring within the window from 30 to 15 msec before the peak of the T wave on the electrocardiogram, 9 produced ventricular fibrillation. Ventricular fibrillation was not produced by impacts at any other time during the cardiac cycle. Of the 10 impacts sustained during the QRS complex, 4 resulted in transient complete heart block. We also studied whether the use of safety baseballs, which are softer than standard ones, would reduce the risk of arrhythmia. A total of 48 additional animals sustained up to three impacts during the T-wave window of vulnerability to ventricular fibrillation with a regulation baseball and safety baseballs of three degrees of hardness. We found that the likelihood of ventricular fibrillation was proportional to the hardness of the ball, with the softest balls associated with the lowest risk (two instances of ventricular fibrillation after 26 impacts, as compared with eight instances after 23 impacts with regulation baseballs). This experimental model of commotio cordis closely resembles the clinical profile of this catastrophic event. Whether ventricular fibrillation occurred depended on the precise timing of the impact. Safety baseballs, as compared with regulation balls, may reduce the risk of commotio cordis.New England Journal of Medicine 07/1998; 338(25):1805-11. DOI:10.1056/NEJM199806183382504 · 54.42 Impact Factor