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Commotio Cordis in Non–Sport-Related Events
Quick Takes
- More than one third of all reported commotio cordis cases are non–sport-related events, occurring in the setting of assault, motor vehicle accidents, and “daily activities.”
- Of note, mortality of non–sport-related commotio cordis was markedly higher, secondary to lower rates of CPR, defibrillation, AED availability, and delayed time to resuscitation compared with sport-related events.
- There is an urgent need for increased awareness of commotio cordis in non–sport-related settings to develop a means of prevention and mortality reduction through earlier recognition and commencement of resuscitation measures.
Study Questions:
What are the mechanisms, demographics, clinical presentation, investigations, and resuscitation outcomes of non–sport-related commotio cordis events in comparison with sport-related events?
Methods:
The investigators searched PubMed and Embase for all cases of commotio cordis from inception to January 5, 2022. Continuous variables were compared using the unpaired Student t test or Welch t test where equal variance could not be assumed based on Levene test for equality of variances. Categorical variables were compared using Pearson chi-square test or Fisher exact test where applicable.
Results:
Of 334 commotio cordis cases identified, 121 (36%) occurred in non–sport-related contexts, which included assault (76%), motor vehicle accidents (7%), and daily activities (16%). Projectiles were implicated significantly less in non–sport-related events (5% vs. 94%, respectively; p < 0.001). Nonprojectile etiologies in non–sport-related events mostly consisted of impacts with body parts (79%). Both categories affected similar younger aged demographic (p = 0.10). The proportion of female victims was significantly higher in non–sport-related events (13% vs. 2%, respectively; p = 0.025). Mortality was significantly higher in non–sport-related events (88% vs. 66%, respectively; p < 0.001). In non–sport-related events, rates of cardiopulmonary resuscitation (CPR; 27% vs. 97%, respectively; p < 0.001) and defibrillation (17% vs. 81%, respectively; p < 0.001) were both lower and resuscitation was more commonly delayed beyond 3 minutes (80% vs. 5%, respectively; p < 0.001).
Conclusions:
The authors report that mortality is higher in non–sport-related commotio cordis, likely owing to lower rates of CPR, defibrillation, automated external defibrillator (AED) availability, and extended time to resuscitation.
Perspective:
This systemic review reports that more than one third of all reported commotio cordis cases are non–sport-related events, occurring in the setting of assault, motor vehicle accidents, and “daily activities.” Of note, mortality of non–sport-related commotio cordis was markedly higher, secondary to lower rates of CPR, defibrillation, AED availability, and delayed time to resuscitation compared with sport-related events. There is an urgent need for increased awareness of commotio cordis in non–sport-related settings to develop a means of prevention and mortality reduction through earlier recognition and commencement of resuscitation measures. It is imperative that future research and public health measures surrounding commotio cordis not overlook non–sport-related events.
Clinical Topics: Arrhythmias and Clinical EP, Prevention, Sports and Exercise Cardiology, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias
Keywords: Accidents, Accidents, Traffic, Arrhythmias, Cardiac, Cardiopulmonary Resuscitation, Commotio Cordis, Death, Sudden, Cardiac, Defibrillators, Resuscitation, Secondary Prevention, Sports, Ventricular Fibrillation
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