Published online March 1, 2006
PEDIATRICS Vol. 117 No. 4 April 2006, pp. e656-e662 (doi:10.1542/10.1542/peds.2005-1270)

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Failure of Commercially Available Chest Wall Protectors to Prevent Sudden Cardiac Death Induced by Chest Wall Blows in an Experimental Model of Commotio Cordis

Jonathan Weinstock, MD^a, Barry J. Maron, MD^b, Christopher Song, BA^a, Paresh P. Mane, MD^a, N.A. Mark Estes, III, MD^a and Mark S. Link, MD^a

^a Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Tufts University School of Medicine, Tufts-New England Medical Center, Boston, Massachusetts
^b Minneapolis Heart Institute Foundation, Minneapolis, Minnesota

OBJECTIVE. Sudden cardiac death that results from chest wall blows (commotio cordis) the second leading cause of death in young athletes. Most events are caused by blows from projectiles, such as baseballs or lacrosse balls, with a substantial proportion occurring despite the use of a chest protector. In the present experiment, we tested the effectiveness of commercially available chest protectors in preventing ventricular fibrillation (VF) that results from chest wall strikes with baseballs and lacrosse balls.

METHODS. Twelve different baseball or lacrosse chest protectors were evaluated in juvenile swines that were subjected to 40-mph baseball or lacrosse ball blows to the precordium during the vulnerable period of repolarization for VF and were compared with control impacts without chest protectors. Seven baseball chest protectors were hit by regulation baseballs, and 5 lacrosse chest protectors were tested by blows with standard lacrosse balls. Each animal received 2 chest blows for each protector and 2 control impacts without a chest protector, with the sequence of impacts assigned randomly.

RESULTS. VF was elicited by 12 (32%) of 37 strikes in control animals without baseball chest protectors. None of the baseball chest wall protectors tested were shown to decrease significantly the occurrence of VF when compared with controls. VF was elicited by 11 (46%) of 24 strikes in control animals without lacrosse chest protectors. None of the lacrosse chest wall protectors tested decreased significantly the occurrence of VF when compared with controls.

CONCLUSION. In our experimental animal model of commotio cordis, commercially available baseball and lacrosse chest wall protectors were ineffective in protecting against VF that was triggered by chest blows and, by inference, sudden cardiac death. Improvements in materials and design of chest wall barriers are necessary to reduce the occurrence of these tragic events and make the athletic field safer for youths.

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Key Words: death • sudden cardiac • arrhythmia • ventricular fibrillation • pediatrics • commotio cordis • athletes

Abbreviations: VF—ventricular fibrillation • ECG—electrocardiogram • LV—left ventricular • BBB—bundle branch block

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Accepted Nov 11, 2005.

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