Damar Hamlin’s doctors say they’re considering commotio cordis as a possible cause of his cardiac arrest. What is it?


January 3, 2023

Buffalo Bills safety Damar Hamlin is beginning to awaken and able to communicate in writing, his doctors said in a press conference in the afternoon of Jan. 5. The positive update on the 24-year-old’s health comes three days after he collapsed following a tackle, went into cardiac arrest, had his heartbeat restored on the field and was rushed to the hospital during the Jan. 2 NFL game against the Cincinnati Bengals.

“There has been substantial improvement in his condition over the past 24 hours,” Dr. Timothy Pritts, division chief of general surgery at University of Cincinnati Health, said. “We had significant concern about him after the injury and after the event that happened on the field, but he is making substantial progress. As of this morning, he is beginning to awaken, and it appears that his neurological condition in function is intact.”

Pritts later shared that when Hamlin awoke, the first thing he asked, using a pen and paper, was whether his team had won the game.

“He’s not quite at the point where we can have a conversation because … he still has a breathing tube in,” Pritts continued. “He’s able to communicate with ‘Yeses’ or ‘Nos,’ shaking his head, nodding his head.”

Hamlin can also move his hands and feet and follow commands, Pritts said.

Hamlin’s doctors are hoping he’ll be able to make a full recovery, but he’s still critically ill, and “there are many, many steps still ahead of him,” Pritts explained, adding that the next hurdle is getting him to breathe on his own. It’s too early to tell when he might leave the intensive care unit or the hospital.

Earlier in the day on Jan. 5, the Buffalo Bills released a statement on Twitter sharing that Hamlin’s lungs are continuing to heal, as well. Hamlin had been sedated and on a ventilator and had sustained some damage to his lungs, his uncle Dorrian Glenn told CNN during an interview in the evening of Jan. 3.

During Monday’s game against the Cincinnati Bengals, Hamlin collapsed after a tackle, and his heartbeat had to be restored on the field, according to a statement from the Buffalo Bills released early Jan. 3. The team confirmed that Hamlin went into cardiac arrest and was rushed to University of Cincinnati Medical Center.

Damar Hamlin of the Buffalo Bills is driven off the field in an ambulance after sustaining an injury during the first quarter of an NFL football game against the Cincinnati Bengals at Paycor Stadium on Jan. 2, 2023, in Cincinnati. Kevin Sabitus / Getty Images

That Hamlin is making progress with his neurological state is an especially promising sign given what he’s been through.

“The biggest concern when the heart stops is that your brain doesn’t get enough oxygen,” NBC News correspondent Dr. Natalie Azar told TODAY in a Jan. 3 segment about Hamlin. “Brain activity stops very, very shortly after someone goes into cardiac arrest, within a couple of minutes.”

It’s unclear exactly how much time passed before Hamlin’s heartbeat was restored. After collapsing, he received CPR on the field for several minutes, according to the ESPN commentators calling the game, as players and fans watched in shock.

In footage of the tackle, Hamlin can be seen taking a hard hit to his chest — after getting up and taking a few steps, his body goes limp, and he collapses onto his back.

Many medical professionals are discussing what might have caused Hamlin’s cardiac arrest. Pritts said the medical team still doesn’t have a definitive answer to this question and that assessments will continue as Hamlin progresses.

One condition that Hamlin’s care team is considering — along with a list of other possible explanations — is called commotio cordis.

What is commotio cordis?

“Assuming he’s a healthy athlete, one condition a lot of experts are looking at is something called commotio cordis,” NBC New senior medical correspondent Dr. John Torres said in a TODAY segment aired Jan. 3. Hamlin had no existing health issues or heart problems, according to his uncle.

Commotio cordis is Latin for “agitation of the heart,” and it occurs when a person gets hit in the chest with a certain amount of force at a very specific time in the heart cycle, when the electricity is flowing from one side of the heart to the other. “Then that can trigger cardiac arrest. … It can be a lethal condition,” Torres said.

The condition is “incredibly rare” a “diagnosis of exclusion,” explained Dr. William Knight IV, director of the Emergency Medicine MLP Program at University of Cincinnati Health, at the Jan. 5 press conference — meaning that “we have to rule out many other more common or more deadly or more fixable type conditions before we can settle in on an ultimate diagnosis such as that.”

“Is it on the list of considerations? It is, but (Hamlin) has many other things that we need to work through before a final … cause for (his cardiac arrest) can be definitively defined,” Knight added.

According to Dr. Khalid Aljabri, a Boston-based cardiologist, commotio cordis is not associated with pre-existing heart damage or the COVID vaccine.

Since 1995, there have only been 200 documented cases of commotio cordis in the United States. It’s mostly seen in athletes between the ages of 8 and 18 partaking in sports with projectiles, according to the University of Connecticut’s Korey Stringer Institute, dedicated to preventing sudden death in sports.

“In the last couple of decades, we have recognized that you can have this non-penetrating blunt trauma to the chest. It happens in baseball (and) in hockey with hockey pucks,” NBC News medical contributor Dr. Natalie Azar told TODAY in a segment aired Jan. 3.

Can commotio cordis happen from a tackle?

“So how could this have happened (during) what looked like … a very typical tackle?” Azar wondered. If the hit to the chest happens at the exact right time in the cardiac cycle, she continued, the impact can trigger a life-threatening arrhythmia (or abnormal heart beat) called ventricular fibrillation. Life-threatening arrhythmias cause most sudden cardiac arrests, according to Cleveland Clinic.

Even a low impact projectile or a strike to the middle of the chest with a hand (during martial arts, for example) can be enough to cause the heart to enter an arrhythmia, per the Korey Stringer Institute.

In addition to the right timing, the impact has to happen in the right location, according to experts.

“Hits like this happen 200, 300 times every weekend in the NFL. … There was nothing extraordinary or particularly different about the hit. It’s probably just where he got hit in the chest,” Peter King, NBC Sports columnist, told TODAY in a segment aired Jan. 3.

Can you survive commotio cordis?

When this condition does occur, “you want to start CPR within two minutes,” Torres said. “They had defibrillators on hand, which I’m sure they used during CPR to try and get him resuscitated.”

Knight and Pritts confirmed that had CPR and defibrillation been delayed by minutes or even seconds, Hamlin’s prognosis likely would’ve been much bleaker.

According to a 2009 literature review of commotio cordis published in Sports Health, resuscitation within 3 minutes resulted in a survival rate of 25%, and that rate dropped to 3% when resuscitation is delayed beyond 3 minutes.

“Cardiac arrest is one of the most time-sensitive diseases in all of medicine. If CPR is not started right away, the chance of survival falls 10% to 15% per minute without CPR,” Dr. Benjamin Abella, director of the Center for Resuscitation Science at the University of Pennsylvania, tells TODAY.com.

“It is a very horrifying, rare thing to witness a cardiac arrest live. … That is a real trauma,” he continues, adding that he hopes Hamlin’s family, teammates, coaches and other witnesses get the support and resources they need to heal.

What is recovery like from commotio cordis?

Even if CPR is successful after cardiac arrest, patients still have a challenging road ahead, Abella says.

“When you look across the United States, survival from the moment cardiac arrest strikes to leaving the hospital is less than 20%,” says Abella. This also depends on when the CPR was started, how well CPR was performed and the availability of automated external defibrillators (AEDs), he adds.

While it is very difficult to say what Hamlin’s recovery will look like, Abella says one thing for certain is recovery will be slow — it could take days, if not weeks, to fully understand the extent of his injuries.

“Brain injury is a common problem after cardiac arrest to varying extents in different people. … We will have to keep hoping for the best, but only time will tell,” Abella says.

“There are some well-known cases of athletes who made full recoveries after cardiac arrest — most notably, Fabrice Muamba in 2012 and Christian Eriksen (in 2021),” Abella continued, adding that both players also had prolonged CPR after their cardiac arrests.

Other possible conditions that could explain Hamlin’s cardiac arrest include an aneurysm that ruptured or an underlying heart defect, Azar said. “We don’t know for sure, but given the timing and the way it happened, (commotio cordis) is what most experts are thinking happened,” she explained.

According to Abella, professional athletes typically undergo extensive screenings and medical evaluation, so it would be surprising to find out now that Hamlin has an underlying heart condition or disorder.

“(It) makes me think that it was probably a blow to the chest in a healthy heart that caused the cardiac arrest,” says Abella, adding that nothing is certain at this stage.

In the meantime, Hamlin’s doctors believe that a full recovery is still on the table.

“The (best-case scenario) is getting him to the way he was at 8 o’clock on Monday evening — completely neurologically intact, strong, good lung function, no … dysfunction with his heart,” Knight said. “The best outcome would be back to who he was before this all happened.”

CLARIFICATION (Jan. 4, 2023, 11:28 a.m. ET): This article previously stated that Hamlin’s uncle Dorrian Glenn said he was resuscitated twice. Glenn misspoke; Hamlin was only resuscitated once on the field, Jordon Rooney, a friend of Hamlin’s speaking on the family’s behalf, told NBC News on Jan. 4

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