What is commotio cordis? Explaining sudden heart stoppage that ‘likely’ led to Damar Hamlin going into cardiac arrestThe Sporting NewsJanuary 5, 2023

Second-year Bills safety Damar Hamlin is in critical condition at the University of Cincinnati Medical Center after collapsing on the field during Buffalo’s “Monday Night Football” contest against the Bengals.

Hamlin required immediate medical attention on the field at Paycor Stadium following a seemingly routine tackle of Cincinnati receiver Tee Higgins. The two collided after a Higgins reception in the first quarter, with Hamlin taking the brunt of the hit to his chest; after getting up from the tackle, the second-year safety from Pitt collapsed onto his back.

Hamlin received immediate medical attention on the field before being transported to the hospital via ambulance. The NFL eventually suspended the game, an unprecedented move, with players and coaches from both teams in obvious distress. Now the world awaits word on his condition.

The Bills released a statement early Tuesday morning saying Hamlin had suffered cardiac arrest. Multiple physicians unconnected to Hamlin’s specific case spoke out on social media and television, saying the 24-year-old’s collapse probably resulted from commotio cordis, which occurs when blunt force to the chest interrupts an otherwise-normal heartbeat.

Here is what you need to know about the condition, its treatment and updates to Hamlin’s status:

What is commotio cordis?

The Mayo Clinic defines commotio cordis as “a hard hit to the chest that causes sudden cardiac death.” The Latin meaning for the term is “agitation of the heart.”

Below is a more detailed definition, via the Mayo Clinic:

Commotio cordis may occur in athletes who are hit hard in the chest by sports equipment or by another player. This condition doesn’t damage the heart muscle. Instead, it changes the heart’s electrical signaling. The blow to the chest can trigger ventricular fibrillation if it strikes at a specific time in the signaling cycle.

Dr. Manesh Patel, chief of cardiology and clinical pharmacology at Duke University, told The Sporting News that Hamlin’s cardiac arrest “likely” was a result of commotio cordis.

Said Patel: “It is hard to speculate exactly what happened, but there is a clinical condition that is called commotio cordis, which is where when you get a blunt trauma to the chest, and it happens unfortunately just at the exact time the heart is repolarizing, or going from a squeezing state back to a resting state and back to a squeezing state, that can cause ventricular fibrillation.”

The Mayo Clinic defines ventricular fibrillation as a type of irregular heart rhythm. During ventricular fibrillation, “the lower heart chambers contract in a very rapid and uncoordinated manner. As a result, the heart doesn’t pump blood to the rest of the body.”

The National Center for Biotechnology Information (NCBI) says commotio cordis is not attributable to structural damage to the heart or surrounding structures, meaning it is strictly an interruption of the heart’s normal electrical operation.

The NCBI added that fewer than 30 cases are reported per year, with the average age in the registry being 15 years old. Per the NCBI, “very few cases have been reported above 20 years old.”

Hamlin is 24 years old.

Patel told TSN that a chain of survival must be followed with anyone suffering cardiac arrest.

“The fastest thing you can do at that point is to do high-quality CPR,” Patel told TSN. “That is the key is to get blood flow to the brain and organs while you get an Automated External Defibrillator (AED) to shock the heart back to a normal rhythm.

“As soon as the arrest happens, we want to make sure blood flows to the rest of the body through CPR. Then, we use the AED sometimes to get the heart back into rhythm.”

The American Heart Association (AHA) reports that CPR can “double or triple a person’s chance of survival.” Following CPR, an AED is used to help restore an effective heartbeat rhythm. It’s a device that analyzes the heart’s rhythm and, if necessary, delivers an electrical shock to reestablish a normal rhythm to the heart.

Patel also said patients can be sedated to help in their recovery.

“Then depending on the state of the patient, we will have the person sedated to let the body rest, sometimes to cool,” Patel said. “So it is not uncommon after cardiac arrest to be sedated and observed so that the body and the brain can recover and rest.”

Reports indicate Hamlin not only was administered CPR and an AED on the field at Paycor Stadium, but was also intubated and sedated at UC Medical Center.

Damar Hamlin heart condition

The Bills confirmed Hamlin suffered cardiac arrest during the game:

The AHA notes that cardiac arrest is different from a heart attack in that the former is an “electrical” problem causing the heart to stop beating. A heart attack occurs when blood flow to the heart is stopped.

It is unknown whether Hamlin suffered any other heart conditions prior to Monday’s game but there has been no previous reporting indicating that he had any issues.

Dr. William Knight of the UC Medical Center said at a news conference Thursday they still are not certain what caused Hamlin’s collapse. 

Chris Pronger injury

Hamlin’s injury has drawn comparisons to that of former NHL player Chris Pronger, who collapsed in a May 11, 1998 Stanley Cup playoff game between the Red Wings and Blues. Pronger even noted the similarity himself, hoping the Bills safety would recover as he did:

The 23-year-old Pronger took a slap shot from Detroit’s Dmitri Mironov just left of his heart. Like Hamlin, Pronger suffered an abnormal heartbeat as a result of blunt force. The Blues defenseman fell down and covered up the puck after getting struck. He then got up before collapsing on the ice. He was unconscious for roughly 20 seconds.

He was stretchered off the ice, but at that point had resumed consciousness and was breathing on his own.

“My eyes roll back in my head and then I went down,” Pronger said in 2015 of the injury (via NHL.com). At the time, you’re young and you don’t take it that serious. But as time goes on, you read about these types of incidents and that kids die from it. I was lucky.”

The blow from the puck caused Pronger’s heart to skip a beat before it returned to a normal rhythm. He spent four days at Henry Ford Hospital in Detroit and was able to return to play four days after the injury.

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