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Damar Hamlin injury sparks discussion of condition known as commotio cordis

By Travis Andersen Globe Staff,Updated January 3, 2023, 1:12 p.m.
Buffalo Bills safety Damar Hamlin pictured during the second half of an NFL football game against the New England Patriots, Thursday, Dec. 1, 2022, in Foxborough, Mass. (AP Photo/Greg M. Cooper)Greg M. Cooper/Associated Press

Buffalo Bills safety Damar Hamlin suffered a frightening injury during Monday night’s game against the Bengals in Cincinnati, when he collapsed after making a tackle and going into cardiac arrest.

Hamlin, 24, was rushed to a Cincinnati-area hospital where he was in critical condition Tuesday. On the play in question, Bengals receiver Tee Higgins led with his right shoulder, striking Hamlin in the chest as Hamlin wrapped his arms around Higgins’ shoulders and helmet to bring him down. Hamlin quickly got to his feet and then fell backward about three seconds later and lay motionless.

While league officials and medical personnel have not said what caused Hamlin to go into cardiac arrest on the field, the disturbing moment has prompted discussion of a rare medical condition known as commotio cordis, which the University of Connecticut’s Korey Stringer Institute says is caused by a “low/mild chest wall impact.”

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“My prayers are with Damar Hamlin,” Dr. Khalid Aljabri, a cardiologist affiliated with Tufts Medical Center, posted on Twitter. “As an arrhythmia specialist, I believe the blow to his chest during a certain period in the cardiac cycle triggered ventricular fibrillation, a condition called Commotio Cordis. It is not associated with pre-existing heart damage or COVID.”

Someone stricken with commotio cordis generally loses consciousness within seconds of their last heartbeat, Aljabri added.

“Damar Hamlin stood up for a few seconds then lost his consciousness,” Aljabri tweeted. “Is commotio cordis still the likely diagnosis? The answer is yes. Loss of consciousness starts about 8 seconds after the last heart beat and circulatory standstill occurs after 10–15 seconds.”

The UConn research institute, named for a former NFL lineman who died from exertional heat stroke in 2001, states on its website that commotio cordis is seen mostly in athletes between the ages of 8 and 18 who play sports with projectiles like baseballs or hockey pucks.

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“These projectiles can strike the athletes in the middle of the chest with a low impact but enough to cause the heart to enter an arrhythmia,” the institute says. “Martial arts is a sport in which a strike of a hand can also cause the heart to change it’s rhythm.”

Without immediate CPR and defibrillation treatment, the site says, the prognosis is grim.

“This condition is extremely dangerous with rare survival,” the site says.

Hamlin was given CPR on the field after he collapsed and his uniform was cut off as he was attended to by medical personnel. ESPN said Hamlin was also given oxygen.

Commotio cordis is a leading cause of “sudden cardiac death” in young athletes, according to a study posted to the website of the National Institutes of Health’s National Library of Medicine.

“Reported cases remain relatively infrequent (less than 30 cases are reported each year), although it is increasingly recognized,” the study says. “The mean age reported in the registry is 15 years, and very few cases have been reported above 20 years old.”

According to the study, a “history consistent with commotio cordis involves a sudden impact with the anterior chest overlying the heart, followed by immediate cardiac arrest. This is most commonly a baseball; however, any impact may be present in the appropriate circumstances.”

Dr. Bernard Ashby, a vascular cardiologist based in Miami, said he also thought Hamlin had suffered from commotio cordis.

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“The video of Damar Hamlin from a cardiologist’s perspective resembled commotio cordis - a phenomenon that occurs when a sudden blunt impact to the chest causes cardiac arrest,” Ashby wrote on Twitter. “Timely defibrillation is life saving & prevents anoxic brain injury. I pray an AED [automated external defibrillator] was near.”

Published reports said Hamlin was also treated with a defibrillator on the field. Anoxic brain injuries are caused by a complete lack of oxygen to the brain.

Ashby’s words were echoed by Dr. Jonathan Reiner, a professor at the George Washington University School of Medicine & Health Sciences.

“Thinking about Demar Hamlin,” Reiner tweeted. “Commotio cordis is caused by an abrupt blow to the chest at exactly the wrong time in the cardiac cycle. Must be resuscitated with an AED.”

Dr. John Mannisi, an interventional cardiologist affiliated with the Lehigh Valley Health Network in Pennsylvania,wrote that applying the AED on Hamlin within four minutes of his collapse “likely would have restored consciousness.”

“He is healthy and young,” Mannisi tweeted, adding that the treating hospital “will start therapeutic hypothermia to minimize anoxic brain injury. I am optimistic he will wake up within 72 [hours] without significant brain injury.”

Dr. Nicole B. Saphier, a radiologist at Memorial Sloan Kettering Cancer Center in New York City, noted that commotio codis is rare and Hamlin’s injury may have been caused by something else.

“Sudden cardiac arrest can be terrifying, especially when it happens to a seemingly healthy 24 year old like Damar Hamlin without known cardiac illness,” Saphier posted on Twitter. “The nature of it brings to question possible Commotio Cordis given it occurred immediately following a blow to the chest.”

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“The most likely scenario is Damar Hamlin had an underlying condition that predisposed him to the sudden cardiac arrest on the field,” she said.

Material from the Associated Press was used in this report.

Read more about Damar Hamlin


Travis Andersen can be reached at travis.andersen@globe.com.

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