Commotio cordis or cardiac concussion is a cause of sudden death in young baseball players. It is the result of a low velocity impact to the chest from a thrown or batted ball traveling usually at a speed of between 20-50 mph. The impact must occur directly over the heart, the closer to the center the greater the risk. The cause of death is the development of an abnormal rhythm, ventricular fibrillation, though there may be some affect on the blood circulation to the heart as well. For the catastrophic event to occur, the impact has to be precisely timed to strike the heart during a 15-30-millisecond phase of the electrical cycle (during repolarization or just before the peak of the T-wave).

Commotio cordis is associated with a death rate of 90%. The lack of response of these young health baseball players to CPR is unexpected and remains unexplained, but it is clear that a rapid response is essential. This response is probably required in three-five minutes…….

Batters should learn ball avoidance and turn away from an inside pitch and not open chest to the impact, as is so typically the case. Avoidance while bunting requires special attention. Pitchers as well should be coached in proper fielding positions and ball avoidance when necessary. Chest wall protectors that are commercially available have not been demonstrated to prevent commotio cordis. Studies with baseballs seems to indicate that lighter and softer balls may diminish the risk, but their acceptability for play by older children is of question.

See Report By USA Baseball Medical And Safety Committee on Commotio Cordis in Baseball

In My Opinion: Studies indicate that the chances of survival of a commotio cordis incident is enhanced if a shock from an AED can be delivered promptly. Most ball parks don’t have AED’s and those that do must have well practiced procedures in place for the rapid use of the device or all if for naught. I am often amazed at the marketing efforts by the vendors of chest protectors. It makes sense that they would help but the scientific studies indicate that many don’t offer any protection and may actually be contra indicated. Apparently, most chest protector vendors need to go back to the drawing board with their designs. Also, the recent high profile lawsuit in New Jersey of a pitcher being stuck by a batted ball that came off of an alleged “hot bat” involves commotio cordis and resulting permanent disability to the pitcher. The metal bat manufacturer was sued among others. What is interesting to note is that commotio cordis usually occurs only when a projectile travels at a relatively slow speed between 20-50 mph and in this case the basis for the lawsuit is that the ball speed was too fast as a result of the alleged “hot bat”. John Sadler