The sports world watched for 9 long minutes recently while Buffalo Bills safety Damar Hamlin lay motionless on the field after a dramatic collapse. While the rest of us prayed for his recovery, a skilled team of medical professionals brought the athlete back to life. But what could have caused a sudden cardiac arrest in such a young professional athlete in peak physical condition?
“The consensus is a rare condition called commotio cordis,” said Dr. Darron Lewis, an interventional cardiologist affiliated with both HCA Florida St. Lucie Hospital and HCA Florida Lawnwood Hospital. “It’s a very rare condition that only happens when there is a perfect storm of events. There has to be impact blunt trauma, forceful to the left chest wall at a certain position of that chest wall – right around the area of the nipple region, at a precise time in the cardiac cycle.
“There are two parts to a cardiac cycle,” Dr. Lewis continued. “The part that makes the heart contract is called polarization and the part that makes the heart relax is called repolarization.
“With an EKG we can look at the time it takes for the heart to start relaxing polarization and this impact has to occur within a specific 20-to-40-millisecond period. If you have that impact exactly at that time, it sends the heart into abnormal heart rhythm called ventricular fibrillation.
“Fewer than 30 cases of commotion cordis are reported per year, with the average age in the registry being 15 years old,” Dr. Lewis continued. “Only 9 percent of those cases happen to people 25 or older. Hamlin is 24 years old. It usually happens in younger athletes because of the density of the chest wall. If you think about the chest wall in a professional football player, it’s very muscular and well-built out. Hamlin has a thick chest wall, and because it’s so muscular that impact had to be just the right amount of force for it this to happen. There is no warning, no screening and absolutely nothing that could have prevented this. As a matter of fact, I read that the NFL has had over 2 million hits and this is the first time this has happened.”
The Mayo Clinic states that commotion cordis may occur in athletes who are hit hard in the chest by sports equipment or by another player. This condition doesn’t damage the heart muscle.
Instead, it changes the heart’s electrical signaling. The blow to the chest can trigger ventricular fibrillation if it strikes at a specific time in the signaling cycle. Ventricular fibrillation causes the lower heart chambers to contract in a very rapid and uncoordinated manner. As a result, the heart doesn’t pump blood to the rest of the body.
The key to survival in this situation is to do immediate, high-quality CPR to get blood flow to the brain and organs while someone gets an Automated External Defibrillator (AED) to shock the heart back to normal rhythm. The American Heart Association reports that CPR can double or triple a person’s chance of survival.
“Hamlin is alive today because of the quick actions of the NFL and the Cincinnati medical staff who quickly observed him pass out and started CPR,” Dr. Lewis confirmed. “They were able to defibrillate him back into normal rhythm and get him to the hospital where they had a skilled team of cardiologists, neurologists and physicians to care for him. It was all about the care he got on the field immediately.”
Reports say Hamlin’s heart stopped for 9 minutes, but Dr. Lewis explained that by doing effective CPR you are still circulating oxygenated blood so the heart is still pumping. That is why it took about 16 minutes to get Hamlin into a waiting ambulance. They wanted to make sure before they stopped CPR that he had a stable heart rhythm.
“A defibrillator is always more effective than manual CPR,” Dr. Lewis explained. “If your heart rhythm generates ventricular fibrillation, no matter how much manual CPR you give, you are probably not going to get that person back. You need an AED. Someone should be administering manual CPR while someone else finds an AED. You don’t need any medical training to operate an AED. The machine will walk you through the process while it finds a shockable rhythm. All you have to do is follow the step-by-step instructions. AEDs are available at most public places like schools, airports, offices, professional games.”
When asked if Hamlin will ever return to sports Dr. Lewis was optimistic. “This was a chance occurrence and he’ll need more tests like a CT scan of the coronary to make sure each coronary comes off exactly where it needs to come off. If his coronaries are normal, I anticipate he may even be back on the field next season,” he said.
If you suspect that someone has gone into cardiac arrest, there are some simple steps you can take that could make the difference between life and death. Unfortunately, 70 percent to 90 percent of people who go into cardiac arrest die before they get to a hospital because people around them don’t know how to help. Since most Americans feel helpless because they don’t know how to administer CPR or they are afraid of hurting the victim, the American Heart Association has been working to educate Americans about the simplified Hands Only CPR.
According to the American Heart Association, Hands Only CPR carried out by a bystander has been shown to be as effective as CPR with breaths in the first few minutes during an out-of-hospital sudden cardiac arrest for an adult victim. Hands Only CPR can be performed with just two easy steps. 1. Call 911; 2. Push hard and fast in the center of the chest to the beat of the Bee Gees classic disco song “Stayin’ Alive.” The song is 100 beats per minute – the minimum rate you should push on the chest during Hands Only CPR. A one-minute training video can be found at heart.org/handsonlycpr.
Dr. Darron Lewis received his medical degree from Ross University School of Medicine, completed fellowships at the University of Louisville/University Louisville Hospital and Virginal Tech Carilion School of Medicine, and his residency at University of Louisville Residency Hospital. He is accepting new patients at his office located at HCA Florida St. Lucie Medical Specialist, 1700 SE Hillmoor Dr., Suite 407, Port St. Lucie. Call 772-335-9600 to schedule an appointment.
