Damar Hamlin Unveils the Reason behind On-Field Collapse: Commotio Cordis

Buffalo Bills safety, Damar Hamlin, collapsed on the field during a Monday Night Football game on January 2 due to commotio cordis, he revealed to the media on Tuesday. He explained that this is caused by a direct blow to a specific point in the heartbeat, resulting in cardiac arrest and collapse. Hamlin was given medical attention and CPR for nearly 20 minutes and was taken to the University of Cincinnati Medical Center for further treatment. He made a swift recovery and was discharged from the hospital on January 9. Hamlin intends to return to the NFL and raise awareness about commotio cordis, the leading cause of death in youth athletes across all sports.

Commotio cordis is a rare cause of cardiac arrest caused by trauma to the heart at a specific point in the cardiac cycle, resulting in a disruption of the electrical pathway and discoordinated contractions of the heart that inhibit proper distribution of blood. If blood is not circulating efficiently or stops circulating, a person's heart cannot supply vital organs such as the brain and lungs, potentially leading to death within minutes. Cardiac arrest is responsible for up to 450,000 deaths each year in the US with 90% occurring outside hospitals. Prompt use of an AED can help restart a person's heart. However, every minute without CPR can lower survival rates by 7-10%.

Commotio cordis can occur in otherwise healthy people, and it's not easily detectable through pre-participation exams or genetic screenings. Research has shown that it seems to affect young male athletes more frequently due to the increasing number of young people participating in sports and their less rigid sternum, which may allow for a blow to push on the heart more easily, causing commotio cordis.

The condition known as commotio cordis is more common among individuals who participate in martial arts or play sports with hard balls such as hockey, lacrosse, or baseball, according to Stearns and Dr. Prutkin. A study tracking 128 commotio cordis cases revealed that 46 occurred during baseball or softball games and 13 during ice hockey games. Although children are the most susceptible to commotio cordis, documented cases have also occurred during high-profile professional sporting events.

In 1998, NHL star Chris Pronger suffered a cardiac arrest on the ice from commotio cordis after being hit in the chest by a puck, causing him to be unconscious for only 20 seconds. Despite being relatively rare in football, Dr. Adler stressed that the NFL had a well-trained staff and quick access to defibrillators with AEDs in case of a commotio cordis incident. The NFL players also undergo electrocardiogram (ECG) testing to detect underlying heart conditions that could make them more susceptible to cardiac arrests.

Although commotio cordis is challenging to prevent completely, Dr. Adler suggested that small changes such as adding more padding and ensuring that athletes have proper equipment could potentially prevent the situation from happening in the future. However, Dr. Adler also explained that Hamlin's case is not evidence of cardiac dangers for NFL players and should not be used as grounds to change the operation of the NFL.

Cardiac arrests that are not freak accidents, such as ones caused by heart disease or genetic conditions, can be detected using ECG testing, but they are not always used routinely before athletes start competing. While the debate about testing all athletes with an ECG is still ongoing, Dr. Adler stressed that identifying individuals with abnormal hearts before they participate in sports is the best way of preventing them from dying on the field.

Dr. Adler also highlighted that cardiac arrest prevention and quick treatment for these cases are often lacking in non-professional settings. While there are initiatives to make AEDs accessible and have CPR-trained personnel at lower-level sporting events, they do not always take place.

“I look down the line of college and even further down into the high school level, and [I wonder] if our high school athletes are getting that same access to really critical care items that could save their life. We know that about 30% of high schools don't have any medical professional hired or on site for them,” Stearns said. “Clearly it can work. But are we providing that same basic care to other athletes as well?'

In addition to Hamlin’s case sparking a conversation about the importance of CPR, it’s also an opportunity to increase awareness about commotio cordis and the ways that it can be effectively treated, whether someone’s playing in the NFL or in Little League.

And despite how scary Hamlin's cardiac arrest was, the small possibility of a person developing commotio cordis should not be reason enough to ditch sports altogether, Dr. Prutkin said, especially when we have effective treatment plans in place.

“This is really rare. We know there's a lot of benefits to playing sports in terms of both physical health and mental health,” he said. “I would really encourage everyone to play sports, if that's a choice that they want to make and something that they enjoy.”