Blunt Impact to the Chest Leading to Sudden Death from Cardiac Arrest 337 Blunt Impact to the Chest Leading to Sudden Death from Cardiac Arrest during Sports Activities B Arry

Background. Sudden death from cardiac arrest in a young person may occur during sports play after a blunt blow to the chest in the absence of structural cardiovascular disease or traumatic injury (cardiac concussion or commotio cordis). We studied the clinical features of this apparently uncommon but important phenomenon. Methods. We identified cases from the registries of relevant agencies and organizations, as well as newsmedia accounts, and developed a clinical profile of 25 children and young adults, 3 to 19 years of age. Results. Each victim collapsed with cardiac arrest immediately after an unexpected blow to the chest, which was usually inflicted by a projectile (such as a baseball or hockey puck). Incidents took place during organized competitive sports in 16 cases and in recreational settings at home, at school, or on the playground in 9. In each instance, the impact to the chest was not judged to be extraordinary for the sport involved and did not appear to have sufficient force to cause death. Twelve victims collapsed virtually instantaneously on impact, whereas 13 remained conscious and physically active for a brief time before cardiac arrest. Cardiopulmonary resuscitation was administered within about three minutes to 19 victims, but normal cardiac rhythm could be restored in only 2 (both incurred irreversible brain damage and died shortly thereafter). Seven victims (28 percent) were wearing some form of protective chest padding. Conclusions. We speculate that most sudden deaths related to impact to the chest (not associated with traumatic injury) are due to ventricular dysrhythmia induced by an abrupt, blunt precordial blow, presumably delivered at an electrically vulnerable phase of ventricular excitability. This profile of blunt chest impact leading to cardiac arrest adds to our understanding of the range of causes of sudden death on the athletic field and may help in the development of preventive measures. (N Engl J Med 1995;333:337-42.) From the Cardiovascular Research Division, Minneapolis Heart Institute Foundation, Minneapolis (B.J.M., L.C.P.); the Office of the New Hampshire State Medical Examiner and the Department of Pathology, Dartmouth Medical School, both in Lebanon, N.H. (J.A.K.); and the National Center for Catastrophic Sports Injury Research and the University of North Carolina, both in Chapel Hill (F.O.M.). Address reprint requests to Dr. Maron at the Minneapolis Heart Institute Foundation, 920 E. 28th St., Suite 40, Minneapolis, MN 55407-3984. S UDDEN death in a young athlete is a dramatic event that has attracted considerable attention. 1 Most such catastrophes have been shown to be the consequence of unsuspected congenital or acquired cardiovascular disease. 2-12 However, we attempted to expand our understanding of sports-related sudden deaths by focusing on a less well recognized cardiac-related cause of death in young healthy people. 13-15 We describe the clinical profiles of a series of young sports participants in whom blunt, nonpenetrating blows to the chest, apparently insufficient to produce structural injury, resulted in cardiac arrest and sudden death.