WEDNESDAY, March 6, 2002 (HealthDayNews) -- Every once in a while in sports, the unthinkable happens. A baseball or a hockey puck or a soccer ball hits a player in the chest -- and the player dies, suddenly, because the heart stops beating.
A first step toward preventing these rare but devastating incidences appears in today's Journal of the American Medical Association, in a study describing why a blow to the chest that ordinarily does no damage can be fatal.
The sudden death, in formal terms commotio cordis, "requires the exquisite confluence of several determinants such as location of the blow directly over the heart and precise timing," a group led by Dr. Barry J. Maron, director of the hypertrophic myocardiopathy center at the Minneapolis Heart Institute Foundation, has determined. And that finding is being applied to give better protection to vulnerable players.
"There is no overwhelming evidence that commercially available products are not of value, but exactly how protective they are is uncertain," Maron says.
Maron and Dr. Mark Link of the New England Medical Center are leading researchers in the field. "We have an ongoing registry of cases and expect to learn more about this unusual syndrome as we get greater numbers," Maron says.
Link and Maron have determined, with the help of animal studies, that for sudden death to occur, the blow must be struck at a specific phase of the heart's contraction. Now Link is working to develop a more effective chest protector.
"The first question was to determine whether protection at all can make a difference," says Mike Oliver, executive director of the National Operating Committee on Standards for Athletic Equipment, which helped finance the research. "If it can, then does the material that is used, its stiffness, the area protected, make a difference?"
As the work progresses, its results are being reported on the committee's Web site, with makers of sporting equipment paying attention, Oliver says.
"We disseminate the results of these research findings," he says. "We make it available to the Sporting Goods Manufacturers Association, which has a representative on our board. We're confident that the manufacturers who make chest protective equipment are following this with interest."
In the millions of encounters of athletes and others with moving objects, Baron and his colleague have identified 107 cases of sudden death, 79 of which happened during sporting events. It is overwhelmingly a problem for young men; the average age of those affected was 14, and 95 percent were male. The majority of these cases happened while the boys were playing baseball; in two cases, it happened although the baseball was softer by design. But it occurred in other sports (hockey, football, lacrosse and soccer) and even in some non-sporting events -- one boy died after getting elbowed in the chest while trying to break up a fight.
It's not an easy problem to solve, says Dr. Jonathan Chang, clinical assistant professor of orthopedics at the University of Southern California and a spokesman for the American College of Sports Medicine.
"The problem is fortunately rare, so it is difficult to come up with some standard for protection," he says. "At what point does the protector become so costly and bulky that you can't play the game? But this needs to have a little more publicity, so that the public is aware of the problem."
What To Do
"This is where good training comes in," Chang says. "As children get older and the ball goes faster, the better the training the less likely this is to occur. Until something better comes along, if players are able to field the ball cleanly, the less likely it is to hit the chest."
You can follow developments of better protection by consulting the National Operating Committee on Standards for Athletic Equipment and the National Collegiate Athletic Association.
Learn more about commodio cordis from this The Physician and Sportsmedicine article.
