Commotio cordis is an often tragic but very unusual, and fortunately relatively uncommon, condition that can take the life of a young, healthy athlete in an instant. It usually occurs when the athlete sustains a blow to the chest - if hit by a pitch in baseball, for instance. The blow, if it occurs during a brief window of the cardiac electrical cycle, can cause a fatal arrhythmia. Because of the depth of this tragedy, while uncommon, efforts have been directed at protecting the participants from this risk, usually by requiring chest protectors. Unfortunately new research suggests that chest protection may not protect against this.
A blunt, non-penetrating blow to the chest can cause a potentially deadly irregular heartbeat called ventricular fibrillation. This kind of impact can occur during hard contact with another player in football or hockey, or when an athlete is hit by a baseball bat, hockey stick, puck, ball or other kind of projectile.
"The difference between a benign blow and commotio cordis is timing," study senior author Dr. Barry J. Maron, director of the Hypertrophic Cardiomyopathy Center at the Minneapolis Heart Institute Foundation, said in a prepared statement. "If the blow occurs directly over the heart at a particular time in the heart's cycle, the results can be catastrophic."
Therein lies the problem. It's the timing more than the severity. Low impact baseballs used in T-ball and little league haven't stopped this from occurring. This condition has been found even in those wearing chest protection.
The researchers found that of the 85 cases involving competitive athletes, 33 (39 percent) of the victims were wearing "potentially protective equipment."
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In 23 of those 33 cases, the players' protective padding was not covering the chest at the time of the blow. In 10 cases, projectiles directly struck the chest protector.
"These athletes wore standard, commercially available chest barriers, made of polymer foam covered by fabric or a hard shell, generally perceived to provide protection from the consequences of chest blows," Maron noted.
Let's look at an article from the University of Maryland on the ACC web site. Should we have all baseball and softball players wear chest protection?
In sports with high-speed projectiles spectators or reserves on the sidelines or in the baseball dugout have also been hit and suffered sudden death.
How minimal a blow can do this?
The non-sporting events included assaults and accidental blows. Several incidents involved impacts that would usually be considered trivial. A plastic baseball bat struck one child and the head of the family dog butted another.
It's important to do the research, and if it's possible to provide protection that actually protects and that doesn't alter the game, then do so. But don't expect that all risk can be eliminated. There's an old Murphy's Law that goes "It's impossible to make a foolproof system because fools are so ingenious." The less amusing corollary is that it's impossible to make a sport risk-free. If your goal is to completely avoid these risks, just like with "Global Thermonuclear War" in the movie War Games, , the only solution is not to play.
