Commotio cordis is a devastating cause of sudden death in young and healthy individuals. Almost half of the events occur during competitive sports, with young males at the greatest risk of sudden death.
These events result from a direct blow to the chest from a hard object, such as a baseball, hockey puck, softball or lacrosse ball. Contact between the object and the young athlete’s chest in a specific phase of the heart’s electrical cycle can trigger ventricular fibrillation and sudden cardiac death. Commotio cordis is the second most common cause of sudden cardiac death in young athletes, second only to hypertrophic cardiomyopathy.
Since harder projectile objects are thought to increase the risk of sudden death from commotio cordis, the US Consumer Product Safety Commission has recommended the use softer “safety” baseballs. In theory, these safety baseball and other soft balls might decrease the incidence of commotio cordis deaths, but they would likely not completely eliminate the risk of it.
Likewise, young athletes should consider wearing chest protectors to reduce the impact of the projectiles. Unfortunately, chest protectors would not prevent every episode of commotio cordis either.
Coaches and parents should stress to kids that they should not attempt to block balls in baseball and lacrosse and hockey pucks with their chest. Leagues could look at adopting rules discouraging this behavior as well.
Finally, the survival rate in these events is poor. Early defibrillation is critical to survival of young athletes, so teams, leagues and sporting facilities should make every effort to have an automated external defibrillator. While early defibrillation does appear to improve outcomes, the total survival rate from commotio cordis is still low – approximately 15%.