What is commotio cordis? Damar Hamlin's tragic accident on field may have triggered rare condition

What is commotio cordis? Damar Hamlin's tragic accident on field may have triggered rare condition
Buffalo Bills safety Damar Hamlin collapsed on the field on January 2, 2023 after colliding into a player (Dylan Buell/Getty Images and @d.ham3/Instagram)

CINCINNATI, OHIO: Damar Hamlin, a Buffalo Bills safety, had a cardiac arrest Monday, January 2, 2023, night in Cincinnati when he collapsed on the field in the middle of a game. He needed CPR to save his life, and he was brought to the hospital in severe condition after what one independent board-certified cardiologist judged to have been a collision at the heart, the key point in the cardiac cycle. “That hit had to occur at a certain point in time that was only five milliseconds long,” said Dr Marc Cohen, Chairman of the Department of Medicine at Newark-Beth Israel Medical Center. “If that hit occurred one millisecond after or before, this may not have happened,” he added.

What appeared to be a routine (by NFL standards) tackle by Hamlin on Bengals receiver Tee Higgins occurred in Hamlin rising to his feet, adjusting his facemask, and immediately collapsing onto his back as shocked players from both sides watched trainers, paramedics, and doctors assist with his breathing and restore his heartbeat.

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What is commotio cordis?

One typical medical explanation is commotio cordis, but that is considered more of an immediate reaction that would make explaining how Hamlin came to his feet difficult. Cohen's knowledge revealed that numerous factors were at work. He said, “There is a time in the cycle of the heart where we are at risk. If we were to tap the heart, we can cause the heart to go into ventricular fibrillation,” Cohen continued, more likely than not, what happened is he got up and his rhythm became chaotic. That may have taken a few seconds to occur.” On the replay, Cohen also saw that Higgins stopped Hamlin's chest, but that Hamlin's head jerked back and forth, he added “When your head goes ping-ponging, it’s very possible that a tremendous amount of adrenaline may be released,” Cohen said, “and that adrenaline triggers the heart to go into a chaotic rhythm, which we call ventricular fibrillation."

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The third idea that occurred to Cohen from a distance is comparable to what was regularly seen in car-crash victims who smashed against the steering wheel before the seat belt and airbag became widespread. Cohen explained, “You would tear your aorta at a certain point in your chest, where the rest of you is going forward, but your aorta is pinned down by some ligaments,” Cohen said. “That would cause a catastrophic tear.”

On-field defibrillation may have restored Hamlin's heartbeat in any of the three scenarios, but it is unclear whether the heart is sufficiently pumping blood to the rest of the body, including the brain's respiratory center. Only a few milliseconds of each cardiac cycle are vulnerable, during which time the heart is most vulnerable to damage from a sudden physical impact. In addition, Cohen praised the first responders for their rapid thinking on the scene and stated that this incident should serve as a "wake-up call" to ensure that safety equipment is easily accessible in all communities to promote bystander CPR.

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Tuesday, January 3, afternoon, the Bills issued a statement stating that Hamlin had spent the previous night in the University of Cincinnati Medical Center's intensive care unit and was still in critical condition. The Bengals-Bills game was put on hold and won't be picked back up this week.

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