Twenty-five children and young adults ages 3 to 19 years collapsed with cardiac arrest after blunt trauma to the left of the sternum. Contusion of the surface of the left side of the chest was often present. The projectiles were commonly baseballs, and the players were most often little league batters struck by a pitched ball. Other sports involved were ice hockey, softball, football, karate, and lacrosse. All were young and none could be successfully resuscitated despite cardiopulmonary resuscitation administered to 19 within 3 minutes. This syndrome has been called cardiac concussion or commotio cordis. Autopsy demonstrated normal hearts without congenital abnormalities or coronary artery injuries. The mechanism of death is thought to be ventricular fibrillation induced by the blow occurring at the upstroke or peak of the T wave, the vulnerable period of the cardiac cycle. Two features of commotio cordis are worth noting: it occurs most frequently in young people, possibly due to their greater chest wall compliance, and the rate of rescue is low. There is only one report of a successful resuscitation of commotio cordis in the literature. "This syndrome is so poorly understood that athletic deaths of this kind have occasionally been regarded as criminal acts rather than physiologic catastrophes." N Engl J Med. 1995; 333: 337.
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