Commotio cordis: a case of ventricular fibrillation caused by a cricket ball strike to the chest

The Lancet (Impact Factor: 45.22). 04/2014; 383(9925):1358. DOI: 10.1016/S0140-6736(14)60486-4
Source: PubMed

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.

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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.
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