Commotio cordis causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Maryam Hadipour, M.D.[2]Cafer Zorkun, M.D., Ph.D. [3]


The most common causes of Commotio cordis are sports that during them the chance of chest trauma with objects or the opponents is high. It can also be seen in cases of child abuse, torture, motor vehicle collisions or fights. There are several measures to reduce the incidence of commotio cordis and its complications in sports such as: having athletic trainers, teaching CPR and the usage of AED among trainers and athletics and other personnel, wearing protective equipment, avoiding weight and strength disparities among athletics.


Many sports may result in commotio cordis, including athletic competitions, swimming, and rugby, among others:

  • baseball
  • cricket
  • hockey
  • lacrosse
  • softball
  • Martial arts

Commotio cordis may occur also in other situations, such as in children who are punished with blows over the precordium, cases of torture, frontal collisions of motor vehicles (the impact of the steering wheel against the thorax, although this has decreased substantially with the use of safety belts and air bags).

Cases of commotio cordis have been recorded in people who were shot by firearms over the precordium and were using body armour[1], thus stopping the bullet but causing a mechanical impact to the thorax (the so-called Behind Armour Blunt Trauma or BABT); or after being hit by less-lethal crowd control firearm shots using rubber bullets or plastic bullets[2].

In contrast, the precordial thump (hard blows given over the precordium with a closed fist in order to revert cardiac arrest) is a sanctioned procedure for emergency resuscitation by trained health professionals witnessing a monitored arrest when no equipment is at hand, endorsed by the latest guidelines of the International Liaison Committee on Resuscitation. It has been discussed controversially, as - in particular in severe hypoxia- it may cause the opposite effect (i.e., a worsening of rhythm- commotio cordis). In a normal adult, the energy range involved in the precordial thump is 5-10 times below that associated with commotio cordis[3].

Although sports-related chest injuries cannot be prevented, some measures can be taken to reduce complications associated with cardiotio cordis, such as death, and avoid automobile accidents resulting in chest injuries.[4][5]

To reduce the incidence of complications of commotio cordis among youth teams and leagues, there are some key steps youth organizations can take:

  • It is essential to have an athletic trainer present whenever there is a practice or a game
  • It is important that AEDs are available at all athletic facilities, as well as being taught to coaches and other personnel involved in the sport how to use when it is needed
  • Training trainers, coaches, parents, and athletes in recognition, CPR, and the use of AEDs in times of commotio cordis.

To reduce the likelihood of a chest injury occurring, a variety of efforts have been made, such as:

  • Wearing the right kind of protective equipment, such as pads, consistently and properly
  • Educating athletes on how to avoid getting struck with a ball puck or another implement that has the potential to cause these kinds of injuries
  • In every case that can be avoided, athletes should avoid weight and strength disparities between themselves
  • Using a safety baseball or hockey puck that has been cushioned to prevent injuries


  1. Cannon L. Behind armour blunt trauma--an emerging problem. J R Army Med Corps. 2001 Feb;147(1):87-96. Review. PMID 11307682
  2. Hiss J, Hellman FN, Kahana T. Rubber and plastic ammunition lethal injuries: the Israeli experience. Med Sci Law. 1997 Apr;37(2):139-44. PMID 9149508
  3. Kohl P, Sachs F & Franz M (eds): Cardiac Mechano-Electric Feedback and Arrhythmias: from Pipette to Patient. Elsevier (Saunders), Philadelphia 2005 ISBN 9781416000341
  4. Link MS (April 2012). "Commotio cordis: ventricular fibrillation triggered by chest impact-induced abnormalities in repolarization". Circ Arrhythm Electrophysiol. 5 (2): 425–32. doi:10.1161/CIRCEP.111.962712. PMID 22511659.
  5. Abrunzo TJ (November 1991). "Commotio cordis. The single, most common cause of traumatic death in youth baseball". Am J Dis Child. 145 (11): 1279–82. doi:10.1001/archpedi.1991.02160110071023. PMID 1951221.

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