Common chest blows can cause sudden death in children

November 12, 2001

ANAHEIM, Calif., Nov. 12 - Seemingly innocent chest blows - even from attempts to remedy hiccups or a blow from a toy plastic bat - can result in rare cases of sudden death in children, according to research presented today at the American Heart Association's Scientific Sessions 2001 conference.

"These fatal chest blows often occurred inadvertently in young children and under bizarre circumstances that are not usually associated with sudden death risk," says Barry J. Maron, M.D., lead author of the study and director of the Hypertrophic Cardiomyopathy Center at the Minneapolis Heart Institution Foundation.

The chest blows came from objects such as a hollow plastic bat, a snowball, a tennis ball filled with coins, a swing, a plastic sledding saucer and baseball-related blows. Bodily contact during shadow boxing, playing with a pet dog, parent-child discipline, gang rituals, intervening in scuffles, and attempts to remedy the hiccups also caused death. These activities often occurred around the home or playground and involved friends, parents and siblings.

Maron says the most vulnerable children are those under the age of 12 whose chest cages are narrow and who have underdeveloped chest muscles.

While deadly chest blows have been recognized as a possibility in sports such as softball or baseball, the fact that they can occur in the home with objects that are not considered dangerous has not been recognized, he says.

"Striking the chest at any time is not advisable under any circumstances, even when the blow is trivial," says Maron. "The general public is largely unaware of the fact that striking the chest, even lightly, can sometimes result in death."

These chest blows, also called commotio cordis, have been associated with sudden cardiac death in the absence of structural damage to the chest wall or heart.

To examine the type and rate of these events, researchers created the U.S. Commotio Cordis Registry and identified 124 cases. The average age of deaths in this category was 14.

About 43 percent of the cases involved children 12 years old or younger, but only 22 percent were 18 or older. The majority were males and the most common cause of commotio cordis (77 cases, or 62 percent) was from organized sports such as baseball, softball or hockey. However, in 38 percent of the cases the chest blows occurred during daily activities or recreational sports.

Only 18 victims in the registry (14 percent) survived commotio cordis, usually because of prompt cardiopulmonary resuscitation (CPR). "These events are devastating consequences of a broad spectrum of life activities, including many occurring during routine daily living," Maron says. "The projectiles are common in everyday life and some of the blows can be very light."

Although the exact number of commotio cordis events is not known, they are rare, according to Maron. Public education and awareness within the lay and medical communities could prevent many of these catastrophes, he says.

While the victims had structurally normal hearts with no heart disease, the strikes occurred over the heart at a precise moment resulting in ventricular fibrillation, cardiac arrest or sudden cardiac death. A strike at the "vulnerable" time of the heart cycle between beats can trigger an abnormal rhythm.

"Any blow to the chest, regardless of its intensity or velocity or force, is capable of producing cardiac arrest," says Maron. The most effective treatment for cardiac arrest is quick CPR and defibrillation (using a defibrillator to deliver an electric shock to the heart). Survival is directly linked to the amount of time between the onset of sudden cardiac arrest and defibrillation. Chances of survival are reduced by about 7 percent to 10 percent with every minute of delay. Few attempts at resuscitation are successful after 10 minutes.

The American Heart Association believes thousands more cardiac arrest victims could be saved annually if more lay persons were trained in CPR and if public access to defibrillation was expanded.

Co-authors are: Thomas E. Gohman, B.A.; Susan B. Kyle, Ph.D.; N. A. Mark Estes III, M.D.; and Mark S. Link, M.D.
-end-
Editor's Note: The American Heart Association has developed a national, community-based initiative called Operation Heartbeat to improve the national sudden cardiac arrest survival rate. Operation Heartbeat focuses on a sequence of four actions called the "chain of survival," a proven method for improving sudden cardiac arrest survival. These include 1) Early Access: recognizing a cardiovascular emergency exists and immediately calling 9-1-1 to access Emergency Medical Services (EMS); 2) Early CPR: performed by a bystander; 3) Early Defibrillation: use of an electric shock to stop the abnormal heart rhythm; and 4) Early Advanced Care-by trained paramedics or healthcare providers. For more information visit www.americanheart.org/operationheartbeat.

CONTACT:
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Abstract 2221

NR01-1361 (SS01/Maron)

American Heart Association

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