A little over a year ago, Steven Domalewski, a 13-year old Little League pitcher from Wayne, NJ was hit in the chest by a line drive. The blow to the chest resulted in a condition called commotio cordis that left Steven in a coma for months after the injury. From the news reports, he has had a long, slow year on the path to recovery, but is now able to speak a handful of words. Doctors, who have called his progress miraculous, hope to restore more language ability and brain function over time. His family has faith that he has the determination to walk again.
As hard as it is to believe, Steven is one of the lucky ones.
According to the national Commotio Cordis Registry, in the period from 1998 to 2007, there have been 188 cases documented cases of commotio cordis, mostly occurring during sports activities: 52 cases in baseball; 13 in softball; 12 in hockey; and 8 in lacrosse. Most notably, the death of 14-year Louis Acompora, a lacrosse goalie from Northport, NY in 2000 prompted his parents, John and Karen, to start a very successful crusade to publicize this rare condition and to get AED's (Automated Electronic Defibrillators) into schools and public venues.
What parents, coaches and players need to know about commotio cordis is this ~
Commotio cordis (Latin for 'commotion of the heart') is the perfect storm of the medical world: a number of elements must combine together in order for an injury to cause commotio cordis rather than just a painful hit to the chest. A blunt blow must be of specific force over an exact spot on the chest, timed to a precise moment in the heart cycle, in the millisecond between heartbeats. The blow causes ventricular fibrillation, which leads to cardiac arrest. Another element in most cases of commotio cordis is that boys and young men are typically the victims, which has been attributed to lack of full development of the chest wall.
For parents, coaches and sports organizations, the key to survival is to have a solid emergency plan in place that includes the following:
- Recognize the signs of cardiac arrest so that no time is lost before treatment begins.
- Mandate CPR and AED training for all coaches (good idea for parents, too)
- Have ready access to an AED and know where it is located
- Realize that time is of the essence: Treatment should begin in under 3 minutes in order to have the greatest odds for survival. Only 20% of commotio cordis victims survive and all were treated in under 3 minutes.
- Don't count on EMS to provide the emergency treatment you need. The most well-equipped areas often clock in response times of 7 minutes or more -- too late for most victims of commotio cordis.
In addition parents and coaches should know that the only form of protection available at this time is education. All kids should be taught never to hit others in the chest, aim any kind of shot to chest and to try to avoid getting hit in the chest themselves. Coaches need to train players not to block with the chest -- just as they would not think of blocking a shot with their face.
And most important, everyone involved in sports like baseball, lacrosse or hockey needs to know that chest protectors do not prevent commotio cordis. Of the sports victims studied by the Commotio Cordis Registry, 32 were wearing chest protectors and only 4 survived. Research is ongoing to develop protective gear that will minimize the risk, but no gear available in today's market protects against commotio cordis.
I was fortunate to be part of the Commotio Cordis Summit in May, hosted by US Lacrosse the governing body for lacrosse. It was an eye-opening day of presentations by the leading doctors and researchers in this field. Most of the data in this post was derived from the information presented that day and therefore, I would like to give credit to the following people: Dr. Barry Maron, founder of the Commotio Cordis Registry; and Drs. Mark Link, Joseph Crisco and Cynthia Bir for their research in the field of commotio cordis. Also, Dr. Jeffrey Mandak and the US Lacrosse Sport Science and Safety Committee deserve big kudos for organizing the summit.
If you would like to read more about commotio cordis, please visit these web sites:
www.suddendeathathletes.org: The Minneapolis Heart Institute Foundation's research and registry of sudden cardiac death in athletes, directed by Dr. Barry Maron
www.nemc.org/medicine/card/commotiocordis.htm: New England Medical Center and Tufts University site describing the research done by Dr. Mark Link
www.USLacrosse.org/safety/aed.phtml: US Lacrosse's information page on Cardiac Science
www.LA12.org: The Louis Acompora Foundation
www.ChainofSurvival.com: General information on cardiac arrest and AED's
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