Posts Tagged ‘commotio cordis’

Commotio Cordis: Proposed NOCSAE Standard for Chest Protectors

“If we can stop a bullet, we can stop a ball”

Baseball is arguably one of the safest team sports. But it’s also where we see the most incidents of commotio cordis, a sudden cardiac arrhythmia caused by a direct blow to the chest. While instances of commotio cordis are rare, one death is too many.

Heart attacks among teen athletes are quite rare, and are most often a result of an underlying physical defect. Commotio cordis has no correlation to the physical health of the victim. According to lab tests at Tufts University Medical Center, it occurs when an object traveling approximately 40 mph makes impact directly over the heart in the milliseconds between heartbeats.

Who’s at risk and why

Catchers, pitchers and infielders are most at risk for blows by high-speed balls. Lacrosse and hockey players are also susceptible to being struck by rocketed balls and pucks. Boys under the age of 15 are most at risk of commotio cordis because their chest walls are still flexible as their bones continue developing into their early 20s.

The best chance victims have for surviving commotio cordis is resuscitation by a defibrillator, a device not housed at every ballfield. And if one is available, there needs to be someone in attendance who has been trained in its proper use.

Equipment manufacturers relying on science to help reduce the risk

But researchers are coming up with another solution. Statistics show that nearly one third of commotio cordis victims collapsed while wearing chest protection of some sort, which means that the protection athletes were given wasn’t good enough.

In January, the National Operating Committee on Standards for Athletic Equipment (NOCSAE) proposed the first standard for chest protectors used in baseball and lacrosse with the intention of reducing the risk of cardiac events. To meet the standard, manufacturers have to come up with a material that will distribute the force of the blow but not affect movements of the players.

Earlier this year, Mark Link, a Tufts University Medical Center heart specialist, published results of tests run on a model made of foam and a combination of polymers that appears promising. The company that developed the material, Unequal Technologies, plans to test it’s chest protectors and heart-covering shirts against the NOCSAE standard. Other manufacturers are visiting the NOCSAE laboratories to educate themselves on the testing process so they can modify their products to comply with the standard.

Source: Lauran Neergaard. “Performance standard proposed for chest protector in baseball, softball.” www. 30 May 2016.

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

Safety Balls in Youth Baseball

Debating the use of reduced-impact ball

The following is an excerpt from the USA Baseball Medical and Safety Committee  report:

Based on the research performed by USA Baseball and other investigators demonstrating that a reduced-impact ball can decrease the incidence and severity of ball impact injuries to less skilled players aged 5-12, the USA Baseball Medical and Safety Advisory Committee recommends:

That youth baseball organizations adopt for their Tee-Ball and other “minor league” programs that are focused on skill development, reduced-impact baseballs that meet NOCSAE standards levels 1 and 2.

  1. This recommendation does not diminish the importance of teaching fundamental baseball skills and ball avoidance skills and techniques for batters.

  2. Current scientific literature on the prevention of commotio cordis by chest protectors is not adequate and therefore the effect of any equipment on the risk of chest impact death remains unsubstantiated at this time.

In my opinion…

I know from the ongoing injury study that I perform for Dixie Youth Baseball (ages 12 and under) that three of the leading causes of injury are being struck by batted balls, thrown balls, and pitched balls. The vast majority of injuries that occur in T-ball and coach pitch are from being struck by batted balls and thrown balls. These injuries in the lower age groups are primarily caused by lack of skills.

Baseball injuries

Based on my personal observation in working with youth baseball players ages 5-8, players learn skills better when some of the fear factor is removed. I would say that softer baseballs definitely remove some of the fear factor, which can result in more quality practice sessions in terms of repetitions and the development of skills. As players move up from T-ball and coach pitch, the skill levels are usually such that the types of injuries that could theoretically be prevented or reduced by reduced-impact balls don’t come into play as often.

From an injury analysis point of view, it is almost impossible to determine if a reduced-impact ball could have prevented or reduced an accident insurance claim. It is much easier to predict the outcome of using other safety equipment such as batter’s face guards or catcher’s throat protectors as they about 99% effective in preventing injury.