Sudden cardiac death due to chest impact with projectiles in sports is rare, but devastating. It’s called commotio cordis. While it’s more common in baseball, the phenomenon has had tragic consequences in lacrosse.

Commotio cordis occurs when a blunt blow to the chest wall directly over the heart happens during a precise moment in the heart’s cycle, disrupting its normal rhythm and causing cardiac arrest. Since 1983, seven lacrosse players have died from such events. Immediate application of cardiopulmonary resuscitation (CPR) and deployment of an automated external defibrillator (AED) to deliver a life-saving shock or defibrillation are the only effective response to commotio cordis.

Grant Mays of Dayton, Ohio, can testify to that.

On May 14, Mays’ Centreville High School team was playing at Moeller High School in Cincinnati when the senior midfielder was hit in the chest by a shot. Shortly after picking up the ground ball, he collapsed. Moeller’s head athletic trainer Craig Lindsey immediately rushed onto the field. Two parents with medical training also came down from the stands.

With Mays unresponsive to initial treatment, the medical team placed the paddles of Lindsey's AED on Mays’ chest and administered one shock. He responded immediately and began breathing on his own. By the time local paramedics arrived and had Mays in the ambulance, his condition stabilized.

“Without the AED, it could have gone the other way,” Lindsey said. “We’re so blessed that it did its job.”

“The AED was the lifeline, but it goes deeper than that,” said Grant's dad Doug Mays. “There has to be trained personnel that know how to use the machine when time is so critical.”

Recent research studies have yielded promising results for an equipment intervention to help reduce the likelihood of commotio cordis. The National Operating Committee on Standards for Athletic Equipment (NOCSAE) may soon approve a performance standard for chest protectors after testing on a mechanical surrogate. The proposal is eligible for final balloting at NOCSAE’s winter meeting Jan. 27.

“This is an unprecedented breakthrough in sports protection,” said Mike Oliver, executive director of NOCSAE. “Scientists have pinpointed the exact cause of commotio cordis, including the critical moment of occurrence in the cardiac cycle and the required threshold to prevent the injury.”

Dr. Mark Link, a board-certified cardiac electrophysiologist and worldwide authority on commotio cordis, conducted substantial research with NOCSAE funding. He tested 12 chest protectors varying in composition on a mechanical surrogate absorbing ball impacts. More than half of the impacts sustained without any chest protection resulted in ventricular fibrillation. Four of the 12 chest protectors significantly decreased the incidence rate to 20 percent or less.

Among products that he has tested, Link said that the HART Protector, produced by Unequal Technologies, may be the closest to meeting the proposed NOCSAE standard. “I am reasonably optimistic that this chest protector ... has the potential to significantly reduce the risk of commotio cordis,” he said.

While chest protectors are primarily associated with baseball catchers and lacrosse goalies, the technology also can be incorporated into the design of protective equipment worn by field players. The most effective material was a composite of four foams with varying density measuring 21 millimeters thick.

“We would advocate for any protective gear to be as widely available to all players as possible,” Doug Mays said. “We accept that there are risks associated with any activity, including lacrosse. But the bottom line is that at the end of the day, we want players to be able to go home.”

SHUTTERSTOCK

Life-Saving Acronyms

While significant research advances offer hope in the development of a more effective equipment intervention for commotio cordis, the only effective response currently continues to be CPR and the deployment of an automated external defibrillator (AED) to deliver a life-saving shock or defibrillation to the heart. Further, the available data shows that resuscitation efforts, including initial CPR, are most effective when initiated within three minutes of the incident.

US Lacrosse has partnered with the American Heart Association to offer discounted training kits to lacrosse organizations that provide hands-only CPR (no mouth-to-mouth) and AED training for coaches and parents.

Hands-Only CPR

1. Call 911 and report your location.

2. Place your hands, one on top of the other, in the middle of the chest. Use your body weight to help you administer compressions that are at least two inches deep and delivered at a rate of at least 100 compressions per minute. Push hard, push fast.

3. Keep performing the chest compressions until the person exhibits signs of life, such as breathing, an AED becomes available, or EMS or a trained medical responder arrives on scene.

This article appears in the January "Sport Science" edition of US Lacrosse Magazine. US Lacrosse recently announced a partnership with the American Heart Association to increase educational opportunities regarding cardiac arrest. Click here to learn more.