What you need to know about Cardiac Arrest and Commotio Cordis in Children's Sports
by Jeremy Manke on Jan 04, 2023
On January 2, 2023, the world watched as Buffalo Bills safety Damar Hamlin collapsed on the field during a Monday Night Football game after taking a hit to the chest. What followed was a masterclass in emergency response — CPR performed immediately on the field, an AED used within minutes, and a life saved because the people around him knew exactly what to do.
Damar Hamlin is from McKees Rocks, just outside Pittsburgh. I watched it happen live from the fire station with my crew. As paramedics and firefighters we knew immediately what we were looking at — and we watched with the same mix of dread and hope that anyone in emergency services feels when they see a resuscitation happening in real time on national television. His story hit close to home in every sense. And it brought a condition called Commotio Cordis into public conversation in a way nothing else ever had.
Here is what every parent, coach, and youth sports organization needs to know.
What Is Commotio Cordis?
Commotio Cordis — Latin for "agitation of the heart" — is sudden cardiac arrest caused by a blunt, non-penetrating blow to the chest. There is no structural damage to the heart. No underlying heart disease. The impact itself, if it strikes at precisely the wrong millisecond in the cardiac cycle, triggers ventricular fibrillation — a chaotic, disorganized electrical rhythm that stops the heart from pumping blood effectively.
It is rare. Approximately 30 cases are reported every year in the United States. Wnhcares But it is the second most common cause of sudden cardiac death in young athletes — and it is almost entirely survivable if people around the athlete know what to do and act within three minutes.
Who Is Most at Risk?
The average age of athletes who experience Commotio Cordis is 10 to 18 years old. Emerson Health Children in this age group are at higher risk because their chest walls are thinner and more flexible than adults — meaning a blow transmits more force directly to the heart.
95% of reported cases occur in boys NCBI — likely reflecting the sports most associated with the condition rather than any biological difference in susceptibility.
Which Sports Carry the Highest Risk?
The most common sports in order of frequency are baseball, softball, hockey, football, and lacrosse. Emerson Health The common thread is a hard projectile — a baseball, hockey puck, lacrosse ball, or softball — traveling at speed toward an unprotected chest. The blow doesn't need to be hard. It needs to be precisely timed.
Soccer, karate, and other contact sports have also produced documented cases. Even a body-to-body collision can cause it if the impact hits the chest directly over the heart at the wrong moment.
Why the First Three Minutes Are Everything
This is the most important thing in this entire article.
Early CPR is pivotal to survival — with a 30-40% survival rate within 3 minutes, contrasting with a 2% survival rate after 3 minutes. Medscape
Read that again. The difference between acting within 3 minutes and waiting is the difference between a 30-40% chance of survival and a 2% chance.
The reason most Commotio Cordis victims die is not because the condition is untreatable. It is because bystanders either don't recognize what happened — assuming the wind was knocked out of the athlete — or they don't have an AED available, or they hesitate.
When an athlete takes a blow to the chest and collapses — does not get up, is not breathing, is unresponsive — do not wait. Call 911 immediately. Start CPR immediately. Get an AED immediately.
What to Do If You Witness a Commotio Cordis Event
The response is the same as any cardiac arrest:
- Call 911 immediately — or have someone call while you act
- Check for responsiveness — tap the athlete's shoulder and shout their name
- Check for breathing and signs of life — for 5 to 10 seconds
- Start CPR immediately — 30 chest compressions followed by 2 rescue breaths
- Get the AED as fast as possible — use it the moment it arrives
- Continue CPR and AED use until emergency services take over
The AED will analyze the heart rhythm and deliver a shock if ventricular fibrillation is detected. This is exactly the rhythm Commotio Cordis produces — meaning AEDs are specifically effective for this condition. Survival has improved concomitantly with increased awareness and access to AEDs at sporting events. NCBI
Prevention — What Coaches and Parents Can Do
You cannot eliminate the risk of Commotio Cordis entirely. But you can reduce it and dramatically improve outcomes if it occurs:
Have an AED at every practice and game. This is the single most important thing. Know where it is before anything happens. Make sure every coach and parent knows where it is too.
Use safety balls for youth baseball. The US Consumer Product Safety Commission recommends that softer safety baseballs be used for youth baseball Wikipedia to reduce impact trauma. Discuss this with your league.
Ensure chest protection fits properly. Chest protectors do not eliminate risk — 11 of 59 Commotio Cordis events occurred despite the presence of chest padding NOCSAE — but properly fitted protection reduces the force transmitted to the chest.
Educate everyone on the sidelines. Coaches, parents, and athletes should all know what Commotio Cordis looks like and what to do. The biggest delay in treatment is time spent figuring out what happened.
Have an emergency action plan. Every sports organization should have a written plan that identifies who calls 911, who gets the AED, who starts CPR, and where the AED is located. Practice it.
Get Trained Before the Season Starts
Reading about CPR and AED use is not the same as being able to perform it under pressure on a field with other people watching and an athlete's life on the line. The hesitation that costs lives is almost always rooted in never having practiced.
We offer AHA and HSI-certified CPR and AED training throughout the Pittsburgh area for sports organizations, coaches, parents, and youth leagues. One session before your season starts could be the difference between a tragedy and a Damar Hamlin story — someone who went home.
If you are a coach or league administrator and want to schedule training for your organization, contact us. We come to you.
This article is for general education only and does not replace professional medical advice, diagnosis, or treatment. Cardiac emergencies require immediate action. When in doubt, always call 911 immediately. If someone collapses at a sporting event and is unresponsive, start CPR and call 911 immediately.
Jeremy Manke is a PA Certified Paramedic and Firefighter with over 20 years of experience. AHA and HSI-certified CPR and First Aid Instructor. Stop the Bleed Instructor. Creator of the Children's First Aid and CPR Kit — built to help parents and caregivers respond confidently to life's emergencies.
