Combatting commotio cordis.

Author:Gorse, Keith M.

WHEN INJURIES OCCUR to young boys and girls in athletics, parents usually think of knees, ankles, or shoulders--not the heart. Commotio cordis, which can strike suddenly in sports such as baseball, softball, lacrosse, and ice hockey, now is being recognized as a cause of death among athletes between ages 4-21. Since 1998, close to 150 youngsters have died from this condition, according to the Commotio Cordis Registry.

A medical term for a rare disruption of the heart's electrical system, commotio cordis is caused by a blow to the chest directly over the heart, which occurs between heart contractions, leading to sudden cardiac arrest. It most often strikes healthy young athletes, due to the pliability of their chest walls. For commotio cordis to take place, the blunt force must strike the heart at a specific point between beats. This causes the heart to go into an abnormal rhythm, such as ventricular fibrillation, and then into arrest. Ventricular fibrillation is a useless quivering of the heart, which results in complete cessation of circulation and deprives the brain and other organs of oxygen. Death can occur within minutes if proper help is not administered by a trained, qualified individual.

There are many ways to help prevent commotio cordis, suggests the National Athletic Trainers' Association, a not-for-profit organization representing 30,000 members of the athletic training profession. Its Age-Specific Task Force offers proactive suggestions to parents and coaches on how to protect young athletes who participate in various contact sports. They include:

* Encourage coaches and officials to become trained in cardiopulmonary resuscitation (CPR), automatic external defibrillator (AED) use, and first aid. It is imperative that commotio cordis is recognized and treated within the first minute of onset. Anything done after this time can diminish the chances of survival. Once the condition is recognized, a trainer or other on-site medical professional should begin CPR or employ an AED--a device that shocks the heart to restore a normal heartbeat--until an EMS technician arrives.

The survival rate of an individual declines approximately 10% for every minute that passes without defibrillation. After 12 minutes, the usual time it takes local EMS to arrive, it usually is too late to revive the victim. When defibrillation is delivered within one minute, the reported survival rate can be as high as 90%. For defibrillation within five minutes, the...

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