Miscellaneous
Evaluation of Chest Barriers for Protection Against Sudden Death Due to Commotio Cordis

https://doi.org/10.1016/j.amjcard.2006.10.053Get rights and content

Blunt precordial blows triggering ventricular fibrillation (commotio cordis) represent a leading cause of sudden death in young athletes. Attention has focused on the primary prevention of these tragedies with chest barriers. The U.S. Commotio Cordis Registry was accessed to determine the likelihood of sudden death in athletes exposed to precordial blows while wearing chest protectors. Of 182 cases of commotio cordis, 85 (47%) occurred during practice or competition in organized sports. In 32 of these 85 competitive athletes (38%), fatal chest blows occurred despite the presence of potentially protective equipment. Athletes wore standard, commercially available chest barriers made of polymer foam covered by fabric or hard shells, generally perceived as protective from arrhythmic consequences of the blows. These events occurred in 4 sports: hockey (n = 13; 1 goalie), football (n = 10), lacrosse (n = 6; 3 goalies), and baseball (n = 3; all catchers). Scenarios included the failure of the padding to cover the precordium so that blows circumvented the protective barrier (n = 25) or projectiles that struck the chest barrier directly (n = 7). In conclusion, a significant proportion (about 40%) of sudden deaths reported in young competitive athletes due to blunt chest blows (commotio cordis) occur despite the presence of commercially available sports equipment generally perceived as protective.

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Methods and Results

The 182 fatal and nonfatal cases consecutively entered into the U.S. Commotio Cordis Registry as of May 2006 were obtained from a variety of sources, including news media, Internet search engines, the LexisNexis database, the U.S. Consumer Product Safety Commission, and submissions to the registry by medical examiners and other medical or sports-related parties.

Each case fulfilled these inclusion criteria3, 4: (1) a witnessed occurrence of a blunt, nonpenetrating chest blow immediately

Discussion

Recent laboratory data have demonstrated commercially available chest barriers to be uniformly ineffective in aborting ventricular fibrillation and commotio cordis.6 This important observation triggered interest in revisiting this issue in our commotio cordis registry. Therefore, we have updated the experience with commercial chest protectors and sudden death in young participants in organized sports after a blow to the chest. In this regard, we found that almost 40% of the competitive athletes

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This study was supported in part by grants from the National Operating Committee on Standards for Athletic Equipment, Overland Park, Kansas; the William Randolph Hearst Foundation, San Francisco, California; Medtronic Physio-Control Corporation, Redmond, Washington; and Philips Medical Systems, Andover, Massachusetts.

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