Commotio Cordis -- Sudden Cardiac Death With Chest Wall Impact

Christopher Madias, M.D.; Barry J. Maron, M.D.; Jonathan Weinstock, M.D.; N. A. Mark Estes III, M.D.; Mark S. Link, M.D.

Disclosures

J Cardiovasc Electrophysiol. 2007;18(1):115-122. 

In This Article

Resuscitation

The survival rate in the U.S. Commotio Cordis Registry is only about 15%, likely due to a lack of early recognition and the failure to initiate timely aggressive resuscitation. Survival is most likely to occur with the institution of cardiopulmonary resuscitation and defibrillation within 3 minutes of the incident event.[1,37] Similar outcomes were seen in our model of CC in which defibrillation with automated external defibrillators (AED) within 1 or 2 minutes of VF resulted in successful resuscitation in 100% and 92% of animals, respectively.[24] Only 46% of shocks were successful after 4 minutes, and after 6 minutes survival decreased further to 25% (P < 0.0001). The AED had 98% sensitivity for recognition of VF and specificity for nonshockable rhythms was 100%. According to these data, more widespread access to AEDs at organized youth sporting events and the training of personnel in their early use would likely achieve substantial increase in the survival of CC victims. Indeed, successful resuscitation of victims of CC with AEDs has been observed.[38,39]

Recently, however, a tragic case of CC was reported in which a healthy 22-year-old college student collapsed suddenly during an intercollegiate lacrosse game after being struck in the chest by an opponent's shot.[37] Despite early AED application and prompt defibrillation (within 2 minutes of his collapse) leading to termination of VF, spontaneous circulation could not be restored and the athlete died an hour later in a neighboring emergency department. The failure to resuscitate this young man despite optimal response time only underscores the importance of developing more effective primary prevention strategies for CC—such as effective chest protectors and safety balls—and promoting their widespread use.

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