Sudden Cardiac Death in Young Athletes
Kevin Gorey, MS
Senior Director, US Council for Athletes’ Health (USCAH)
**Sensitive Content: This article depicts instances of sudden death of children and may be sensitive to some readers.**
What Causes Sudden Cardiac Death (SCD) in Young Athletes?
Most cases of SCD in young athletes are due to hidden heart defects or overlooked heart abnormalities. These deaths usually occur during practice or games. Another condition that can cause SCD is commotio cordis. Unrelated to any pre-existing heart conditions and caused by blunt cardiac injury, it accounts for approximately 20% of sudden cardiac deaths.
What is commotio cordis?
Commotio cordis occurs when a person is hit in the chest and that impact triggers a dramatic change in the rhythm of their heart. A projectile, such as a batted or thrown baseball, can cause a blow to the chest that results in commotio cordis. Researchers have found in animal studies that the optimum speed for a baseball to cause commotio cordis is only about 40 miles per hour. Many baseball pitchers can easily throw at that speed.
Keep in mind that optimum speed does not mean the minimum speed. There is a documented case where a father underhand-tossed a softball to his 6-year-old son at a picnic. The ball skimmed off the child’s glove, hit him in the chest, and caused a fatal cardiac arrest.
This may explain why that in most reported cases of commotio cordis, sudden death follows a seemingly benign blow to the chest. In these situations, witnesses have generally believed that the blow to the chest wasn’t hard enough to cause a serious injury.
What is the incidence of commotio cordis?
The U.S. Commotio Cordis Registry in Minneapolis, MN tracks cases of commotio cordis and has documented over 250 occurrences since its formation. Approximately 10-20 events are added to the registry every year. The actual incidence is believed to be greater, though, due to lack of recognition and underreporting.
Commotio cordis occurs most frequently in young people under the age of 18 during sports activities. The most recent data indicates that 53% of the victims were engaged in organized competitive athletics, while the rest were involved in normal daily activities (23%) or recreational sports (24%).
Healthy young athletes are especially at risk because of the pliability of their chest walls. One study of 55 cases of sudden cardiac arrest (SCA) found that 90% were 16 years old or younger. All were playing sports either organized or informally. None of these children showed evidence of any heart defect or disease.
Typically, when a young athlete collapses on the field, people are confused and unsure of what to do. This confusion delays necessary treatment and lowers the chance of survival.
Can These Sudden Cardiac Deaths Be Prevented?
The only true prevention of commotio cordis is to eliminate blows to the chest, so realistically there is no way to prevent it in sports like baseball.
The only proven prevention strategy for SCD is through emergency preparedness. Use of an Automated External Defibrillator (AED) dramatically increases survival rates if used within minutes of a collapse.
With defibrillation (use of AED) at one minute, the survival rate can be as high as 90%. Within 5 minutes, the survival rate can be as high as 50%. The survival rate of SCA decreases 7-10% for every additional minute that passes without defibrillation. By the time the Emergency Medical Services (EMS) typically arrive (9-12 minutes), the survival rate drops to 5%.
Importance of Emergency Action Plans
Emergency action plans are a critical component of the emergency response program for any sports team or organization. Not only should they be updated as often as necessary, but they also need to be readily accessible at all practice and game facilities.
The one action that can prevent deaths from sudden cardiac arrest is responding quickly and appropriately. Part of that response includes knowing CPR and having access to a functional AED.
Training parents, umpires, coaches and other staff to recognize commotio cordis, provide basic life support, and respond quickly is essential to a successful outcome. All coaches and staff should be trained in CPR and AED administration annually.
The sudden, unexpected death of a young athlete is a tragedy. It not only affects family and friends, but it also affects the coaches, players, league and entire community. It is natural for everyone to wonder what could have been done to prevent this sudden cardiac death. Now we know.
**For more information about keeping your athlete safe during baseball season, check out USA Baseball’s Health and Safety Resources.**
Kevin Gorey is a Senior Director at the U.S. Council for Athletes’ Health (USCAH). Kevin brings extensive experience from both commercial health care and sports medicine to the USCAH team. His three-decades long professional experience has produced high-level results for the organizations he has had the privilege to work with.
The U.S. Council for Athletes' Health (USCAH) was founded upon the need for trusted, independent athletic health care partners with the experience and expertise to advise and consult with organizations regarding their healthcare delivery system. This is why USCAH is committed to providing independent and unbiased medical expertise to organizations and individuals dedicated to the optimal health and safety for the athletes they serve. You can find out more about USCAH at www.uscah.com or by reaching out to [email protected]