Commotio Cordis

 

If you hadn’t heard of commotio cordis prior to this past week, you likely have now. On January 2, 2023, Damar Hamlin of the Buffalo Bills made a tackle, got up, and collapsed backwards onto the field. CPR was administered due to cardiac arrest. Many of us in sports medicine started to speculate, for better or worse, a differential diagnosis and commotio cordis was commonly suggested on social media. From what we know at the time of this podcast recording, a cardiac event occurred, whether it be commotio cordis or not.

But what exactly is this condition?

It’s something that is talked about in sports medicine frequently as a rare condition that occurs if there is blunt trauma to the chest that occurs during a specific point of the cardiac cycle. Today on the podcast, I have an expert who has spent a good portion of his career in cardiology contributing to our knowledge of this condition. So… let’s learn.

 

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Links from this Episode:

— Dr. Mark Halstead: On the WebOn Twitter

— Dr. Mark Link: On the Web

— NOCSAE https://nocsae.org/

— Buffalo Bills https://www.buffalobills.com/

— Damar Hamlin https://www.nfl.com/players/damar-hamlin/
— Damar Hamlin Twitter : @hamlinisland https://twitter.com/hamlinisland?lang=en

— Maron BJ, Poliac LC, Kaplan JA, Mueller FO. Blunt impact to the chest leading to sudden death from cardiac arrest during sports activities. N Engl J Med. 1995 Aug 10;333(6):337-42. doi: 10.1056/NEJM199508103330602. PMID: 7609749. https://pubmed.ncbi.nlm.nih.gov/7609749/

— Maron BJ, Ahluwalia A, Haas TS, Semsarian C, Link MS, Estes NA 3rd. Global epidemiology and demographics of commotio cordis. Heart Rhythm. 2011 Dec;8(12):1969-71. doi: 10.1016/j.hrthm.2011.07.014. Epub 2011 Jul 18. PMID: 21763255. https://pubmed.ncbi.nlm.nih.gov/21763255/

–Maron BJ, Haas TS, Ahluwalia A, Garberich RF, Estes NA 3rd, Link MS. Increasing survival rate from commotio cordis. Heart Rhythm. 2013 Feb;10(2):219-23. doi: 10.1016/j.hrthm.2012.10.034. Epub 2012 Oct 26. PMID: 23107651. https://pubmed.ncbi.nlm.nih.gov/23107651/

— Link MS, Estes NA 3rd, Maron BJ; American Heart Association Electrocardiography and Arrhythmias Committee of Council on Clinical Cardiology, Council on Cardiovascular Disease in Young, Council on Cardiovascular and Stroke Nursing, Council on Functional Genomics and Translational Biology, and American College of Cardiology. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 13: Commotio Cordis: A Scientific Statement From the American Heart Association and American College of Cardiology. Circulation. 2015 Dec 1;132(22):e339-42. doi: 10.1161/CIR.0000000000000249. Epub 2015 Nov 2. PMID: 26621653. https://pubmed.ncbi.nlm.nih.gov/26621653/

— Kumar K, Mandleywala SN, Gannon MP, Estes NA 3rd, Weinstock J, Link MS. Development of a Chest Wall Protector Effective in Preventing Sudden Cardiac Death by Chest Wall Impact (Commotio Cordis). Clin J Sport Med. 2017 Jan;27(1):26-30. doi: 10.1097/JSM.0000000000000297. PMID: 27014942; PMCID: PMC5181132. https://pubmed.ncbi.nlm.nih.gov/27014942/

— Link MS, Maron BJ, Stickney RE, Vanderbrink BA, Zhu W, Pandian NG, Wang PJ, Estes NA 3rd. Automated external defibrillator arrhythmia detection in a model of cardiac arrest due to commotio cordis. J Cardiovasc Electrophysiol. 2003 Jan;14(1):83-7. doi: 10.1046/j.1540-8167.2003.02017.x. PMID: 12625616. https://pubmed.ncbi.nlm.nih.gov/12625616/

— Weinstock J, Maron BJ, Song C, Mane PP, Estes NA 3rd, Link MS. Failure of commercially available chest wall protectors to prevent sudden cardiac death induced by chest wall blows in an experimental model of commotio cordis. Pediatrics. 2006 Apr;117(4):e656-62. doi: 10.1542/peds.2005-1270. Epub 2006 Mar 1. PMID: 16510614. https://pubmed.ncbi.nlm.nih.gov/16510614/

— Link MS, Maron BJ, Wang PJ, Pandian NG, VanderBrink BA, Estes NA 3rd. Reduced risk of sudden death from chest wall blows (commotio cordis) with safety baseballs. Pediatrics. 2002 May;109(5):873-7. doi: 10.1542/peds.109.5.873. PMID: 11986449. https://pubmed.ncbi.nlm.nih.gov/11986449/

— Link MS, Wang PJ, Pandian NG, Bharati S, Udelson JE, Lee MY, Vecchiotti MA, VanderBrink BA, Mirra G, Maron BJ, Estes NA 3rd. An experimental model of sudden death due to low-energy chest-wall impact (commotio cordis). N Engl J Med. 1998 Jun 18;338(25):1805-11. doi: 10.1056/NEJM199806183382504. PMID: 9632447. https://pubmed.ncbi.nlm.nih.gov/9632447/

 

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The Host of this Program:

Dr. Mark Halstead - Host of The Pediatric Sports Medicine Podcast - St. Louis, MOMark Halstead: 

Dr. Mark Halstead received his medical degree from the University of Wisconsin Medical School. He stayed at the University of Wisconsin for his pediatric residency, followed by a year as the chief resident. Following residency, he completed a pediatric and adult sports medicine fellowship at Vanderbilt University. He has been an elected member to the American Academy of Pediatrics (AAP) Council on Sports Medicine and Fitness and the Board of Directors of the American Medical Society for Sports Medicine (AMSSM). He has served as a team physician or medical consultant to numerous high schools, Vanderbilt University, Belmont University, Washington University, St. Louis Cardinals, St. Louis Blues, St. Louis Athletica, and St. Louis Rams. He serves and has served on many local, regional and national committees as an advisor for sports medicine and concussions. Dr. Halstead is a national recognized expert in sport-related concussions and pediatric sports medicine.

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The Guest Featured Inside this Program:

Mark Link: A Guest on The Pediatric Sports Medicine PodcastMark Link: 

Dr. Mark Link is a Professor in the Department of Internal Medicine, Division of Cardiology at the University of Texas Southwestern Medical Center. He is a native of Sioux Falls, South Dakota. He earned his medical degree at Tufts University followed by his residency in internal medicine at Columbia Presbyterian in New York. Following residency he served as an internist for the US Air Force. Following an honorable discharge from the Air Force, he completed a fellowship in cardiology and cardiac electrophysiology at Tufts University in Boston. He stayed on as faculty there in 1997, where he rose to the level of Professor in 2008. He was recruited to UT Southwestern in 2016. He has been a primary investigator or collaborating author on 135 articles and more than 140 abstracts and has contributed more than 100 chapters and invited reviews for medical textbooks and journals. He has served on the editorial boards of multiple publications and is considered a national expert in electrophysiology.

— Dr. Dr. Mark Link: On the Web