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When a Batted Baseball Can Mean Sudden Death for Young Ballplayers

When a Batted Baseball Can Mean Sudden Death for Young Ballplayers

The odds of a young athlete being affected by commotio cordis are relatively low, but the stakes are high. (Getty Images)

On a spring Sunday in Houston in 2015, Walker Johnson, then 13, was the picture of health, winding up and hurling pitches for his youth baseball team. It all changed in a moment, when an opposing batter smashed a hard line-drive that slammed into the boy's chest. Walker dropped to his knees, then collapsed. A moment later, he was unconscious. The boy's father ran to his side, checked for a heartbeat and found none.

Fortunately, Walker woke up on his own and an ambulance arrived quickly, reportedly within two minutes, and Walker survived an unusual but potentially fatal cardiac event: commotio cordis, which is a disruption of the heart rhythm. This medical condition can occur when a hard object – like a baseball – strikes the chest of a child or teenager near their heart at a speed of 30 to 50 mph, says Dr. Lisa C. D'Alessandro, the cardiologist at Texas Children's Hospital in Houston, who treated Walker. Commotio cordis – "agitation of the heart" in Latin – is reported nationally 10 to 20 times annually, and about half the cases are fatal, says Dr. Mark Link, a cardiologist at UT Southwestern Medical Center in Dallas. Link has studied the arrhythmic event for 20 years. Most of the athletes affected are boys or male teenagers, Link says. About 50 percent of commotio cordis cases occurred during competitive sporting events, and another 25 percent happened during recreational sports games, according to research published in the journal Medicine, Science and the Law in 2017. Most victims had no preexisting heart disease, Link says.

A series of events have to occur in just the right sequence for the heart rhythm disruption to occur. A hard object, such as a baseball, hockey puck or lacrosse or field hockey ball, must strike the left side of the person's chest, near the heart, between heartbeats, causing a "chaotic rhythm" that can cause sudden cardiac death, Link says. The strike has to occur with a 10- to 20-millisecond window of time, when the heart is relaxing electrically, making it vulnerable to such an impact, D'Alessandro says.

People who suffer this condition are victims of "sheer bad luck to be hit in that part of their body during that part of the heart cycle," says Douglas Casa, chief executive officer of the Korey Stringer Institute at the University of Connecticut in Storrs, Connecticut.

Younger boys and teenagers are probably at greater risk than adults for commotio cordis because their chest muscles aren't fully developed, Sink says. Far more boys than girls are affected, likely because greater numbers of young male athletes play sports that involve a hard projectile than girls.

While the odds of a young athlete being affected by commotio cordis are relatively low, the stakes are high. Experts recommend these strategies to keep young athletes safer and improve their chances of surviving if they do experience commotio cordis:

1. Learn CPR, or make sure someone at youth games knows it. Immediate treatment is crucial, Link says. Whenever kids are playing competitive baseball, hockey, field hockey or lacrosse – any sport with a hard projectile – there should be an athletic trainer on hand who knows CPR, Casa says. Performing CPR immediately and keeping the compressions going until paramedics arrive can save a child's life. If an athletic trainer isn't available, a responsible adult, such as a coach or a parent, should be at the game and prepared to do CPR if needed, Casa says.

2. Remember, you don't necessarily have to do mouth-to-mouth resuscitation. If a teenage athlete suffers commotio cordis, you can help without putting your mouth on his or hers, says Dr. Richard F. Wright, a cardiologist at Providence Saint John's Health Center in Santa Monica, California. "[Commotio cordis] is treatable, if aid is provided right away," he says. "All you have to do is press [hard and fast on] the chest." The American Heart Association says that hands-only CPR is ideal for teens and adults, but recommends that anyone younger (such as prepubescent boys) should receive CPR with rescue breaths. The AHA, the American Red Cross and many municipalities and community centers offer CPR training. In and around the District of Columbia, for example, the American Red Cross provides training in CPR and in the use of automated external defibrillators – portable devices that deliver electronic shocks to the heart that can stop an irregular heartbeat so the normal rhythm can resume – starting at $73. You can visit redcross.org to find a training program near you. The American Heart Association also has an online tool you can use to search for CPR and AED courses in your region. There are online and video training courses for CPR for less than $50; there are also at-home training kits like CPR Anytime. Under AHA and American Red Cross guidelines, people seeking CPR certification must successfully complete a course that includes an in-person skills session with a credentialed instructor.

3. Try to have a defibrillator nearby. Athletic leagues in which kids play with hard projectiles should try to have a defibrillator at each game, as well as someone who's trained in how to use it, Casa says. While CPR can buy time until rescue workers arrive, a defibrillator can restart the heart, he says. "You want to have the piece of equipment that can start the heart back up, so you're not waiting for an ambulance," Casa says. "The defibrillator is a game-changer." You can buy a defibrillator online for prices ranging from about $786 to $1,500 per unit. Sports leagues should provide training on how to use the devices, Casa says. At least one major youth sport governing body is working to provide these resources. US Lacrosse, the national governing body for 450,000 players (most of whom are 15 and younger), provides free or reduced-price defibrillators to coaches, says Bruce Griffin, director of health and sports safety for the group.

4. Avoid large strength disparities on the field or on the ice. Young athletes are more vulnerable to experiencing commotion cordis when they're matched up against players who are much stronger physically, Casa says. For example, a slight 14-year-old playing field hockey against a player the same age who's gone through puberty and weighs 180 pounds is at greater risk, Casa says. That's because the larger player can put a much higher velocity on the ball when he strikes it than other competitors. Coaches should also be careful, Casa says. A baseball coach taking some swings against a pre-teen pitcher could hit the ball hard enough to strike a player in the field in the chest and cause commotio cordis. The odds of a player suffering the arrhythmic event go way down "if an 8-year-old is playing against a [similarly sized] 8-year-old," Casa says.

5. Be sure athletic protective gear fits well. Goalies in ice hockey and field hockey and baseball catchers wear protective chest padding that can help prevent injury. To achieve optimal protection, make sure the gear fits snugly and doesn't have any gaps where a puck or ball could shoot through, Casa says.

6. Consider equipment changes. Youth baseball leagues should consider using balls that are softer than the regulation versions, Wright says. Kids who are struck with softer balls are much less likely to incur commotio cordis or other injuries than if they were hit by the harder regulation baseball, he says.

7. Have an emergency plan. Youth league coaches and officials should develop specific strategies for responding to a cardiac emergency, Casa says. For example, a plan could designate one coach to administer CPR while another calls 911; a parent could be tasked with going out to meet and guide emergency responders. Without a plan, parents, coaches and bystanders will have to scramble, Casa says.

Story Credit: https://health.usnews.com/health-care/patient-advice/articles/2018-06-07/commotio-cordis-a-rare-deadly-heart-event