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Damar Hamlin collapsed during an NFL game. What happened?

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When Damar Hamlin’s heart stopped beating on Monday night during a National Football League game between the Cincinnati Bengals and the Buffalo Bills, the crowd fell silent.

Hamlin, a Bills safety, had received a blow to the chest from a Bengals receiver’s shoulder in what appeared to be a routine play. Then he got up, took a few steps, and then fell on his back, where he lay motionless.

According to report from the scenestaff managed Resuscitation (CPR) on the field, and a automatic external defibrillator (an AED) was by his side. Have accounts representatives confirmed his heart stopped – but then restarted – on the field.

After several minutes, an ambulance rolled onto the field and transported Hamlin to the University of Cincinnati hospital, where he was in critical condition. from Tuesday afternoon.

Injuries on the football field are more common than in any other popular professional sport: more than three times as many injuries happen during NFL games as well as professional basketball, baseball, hockey, and football games combined.

But when we think of football-related injuries, we usually think of concussions and musculoskeletal issues. Heart injury, not so much.

It is still unclear what happened to Hamlin during Monday night’s game. However, it’s possible for the heart to stop beating after a hard, targeted blow to the chest — an event called commotio cordis in medical terms, from the Latin for “agitation of the heart.” And while it’s a well-described sports injury, it’s not something most NFL viewers are familiar with.

That’s because commotio cordis is incredibly uncommon, said Mark Link, a cardiologist at the University of Texas Southwestern Medical Center. These types of injuries generally cause between 15 and 20 deaths per year.

And they’re especially rare in adults, Link said. “Usually the average age is around 15, so Damar was a bit old for this,” he said. Hamlin is 24.

While the situation is still evolving, it’s worth understanding what this unusual condition is, who is more at risk, and how athletes – especially young athletes – can protect themselves.

Commotio cordis is a disturbance of the heart’s contractions – and it is deadly if not treated immediately

When a person’s heart stops beating after a chest injury, it’s usually because the blow was hard, focused, and localized just enough to beat the heart out of its usual rhythm. The lower chamber of the heart, whose rhythmic contractions normally drive the body’s circulation, simply vibrates in a disorganized manner.

As a result, the injured person has no blood pressure and no circulation of oxygenated blood to the brain and the rest of the body’s organs. If circulation is not restored within minutes with CPR and an AED, the lack of oxygen will inevitably lead to death. The percussive motion of CPR circulates blood to the brain and organs as the heart falters, and the AED shocks the heart back to restore a normal rhythm.

The impact doesn’t necessarily injure — that is, bruise or otherwise damage — the heart muscle itself. That means that in the case of commotio cordis, the heart should be able to function normally once the rhythm is restored. However, if the heart muscle has suffered damage, such as from a blow to the chest during a car accident, the outcome may be more complicated and require more medical intervention and recovery time after the event.

Buffalo Bills players stand and kneel on the football field.  The picture shows an ambulance.

Buffalo Bills players react after teammate Damar Hamlin was injured during the first quarter of the game against the Cincinnati Bengals on Jan. 2.
Kirk Irwin/Getty Images

The prompt medical response Hamlin received on the field likely increased his chances of a full recovery. “CPR is possible if you are resuscitated promptly and promptly with an AED — and both things seemed to be the case” for Hamlin, Link said.

“That’s a crucial lesson from this point on,” he said. “Everyone should be prepared for something like this to happen at sporting events.” That means there’s an AED nearby and people trained to perform CPR (and recognize the need for it).

The condition is unusual in that it takes many factors to align exactly

Athletes take a lot of blows to the chest, so why don’t we see more of this injury?

Several specific elements must line up at the same time for a hard thump to the chest to lead to cardiac arrest.

Heart rhythms are only vulnerable to disruption from violence for a small time frame — during just 1 to 2 percent of the heart’s pumping cycle, Link said.

In addition, the impact must occur in a very specific place: just above the heart. The force of the impact must be significant, and the object causing the impact must be small enough to concentrate a lot of force in a very small area, such as a baseball or lacrosse ball. (While the larger size of footballs and soccer balls theoretically make them less likely to cause commotio cordis because they distribute force more widely, multiple recent reports have described the condition following a chest impact from a soccer ball.)

The condition is more common in younger athletes because their chest walls tend to be thinner than adults, meaning their hearts are less protected from the force of an impact. That’s why — while most of the cases reported each year are young baseball players — Link has never heard of a case that plays out in professional baseball, let alone professional basketball or football.

Prevention is possible… but probably won’t become standard in pro football

Again, it’s rare for an adult athlete to have their heart stopped from an impact.

Commotion cordis is also rare in youth sports – but when it happens, the consequences are huge. It is associated with such high mortality rates that chest protection is now becoming the standard in a range of youth and young adult sports.

The National Operating Committee on Standards for Athletic Equipment has approved chest protectors now prescribed by the National Collegiate Athletic Association for lacrosse goalies and by the organization that regulates American high school baseball for catchers. And while other sports or positions may not mandate this equipment, committed players can certainly use it.

It’s unlikely these items will become mandatory for professional athletes because the risk from the event is so much lower than for young people, Link said. “Making chest protection mandatory for them doesn’t make much sense because they’re just so much less susceptible,” he said.

While what happened to Hamlin was shocking, Link said it’s important to put the event in context. Athletes are more likely to die from a motor vehicle accident on their way to the field than to be punched in the chest during a game.

“Sports are great for kids and they should keep playing them – and wear their seatbelts on their way to practice,” he said.


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