Posts Tagged ‘cardiac arrest’

Commotio Cordis in Youth Baseball

The AED, chest protectors and safety ball factors

Following is a summary of an excerpt from the USA Baseball Medical And Safety Committee’s report on Commotio Cordis in Baseball:

Commotio cordis or cardiac concussion can cause sudden death in young baseball players. It is the result of a low velocity impact to the chest from a thrown or batted ball, usually traveling at a speed of between 20 and 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 such a catastrophic event to occur, the impact has to be precisely timed to strike the heart during a 15 to 30-millisecond phase of the electrical cycle.

There is a 90 percent death rate among those suffering commotio cordis. The lack of response to CPR efforts by healthy young baseball players is unexpected and remains unexplained. However, it is clear that a rapid response time – three to five minutes – is critical.

Batters should learn ball avoidance and turn away from an inside pitch and not open the 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 demonstrated to prevent commotio cordis. Studies with baseballs seem to indicate that lighter and softer balls may diminish the risk, but their acceptability for play by older children is of question.

In my opinion…

Studies indicate that the chances of surviving an incident of commotio cordis is enhanced if a shock from an automated external defibrilator (AED) can be delivered promptly. Most ball parks don’t have AEDs and those that do must have well-practiced procedures in place for the rapid use of the device. Otherwise all is 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 high-profile lawsuit in New Jersey of a pitcher being stuck by a batted ball that came off of an alleged “hot bat” involved commotio cordis resulting in a permanent disability to the pitcher. The metal bat manufacturer and others were sued. What is interesting to note is that commotio cordis usually occurs only when a projectile travels at a relatively slow speed, usually between 20 to50 mph. In this case the basis for the lawsuit was that the ball speed was too fast as a result of the alleged “hot bat”.

  – John Sadler