call 911, start CPR and use AED

Tue April 18, 2023 6:10 PM

An expert physician from the American Heart Association provides commentary and perspective on an unusual condition believed to have afflicted NFL player Damar Hamlin, which is due to blunt force trauma to the heart at exactly the wrong time of the heartbeat

Guest Editorial by the American Heart Association

An emotion of the heart (kə-ˈmō-shē-ō-ˈkȯrd-əs) is an extremely rare and highly unusual cardiac event, but it is vitally important for everyone to be aware and recognize how to act quickly in any type of cardiac emergency.

According to the American Heart Association, it is essential to quickly recognize the cardiac emergency and immediately begin the three most important steps in the chain of survival: 1) call 911, 2) start CPR and 3) defibrillate with a automated external defibrillator or an AED. . These are the only ways to save someone’s life after a commotio cordis or cardiac arrest.

The American Heart Association is the leader in resuscitation science, education and training, and the publisher of the “Guidelines for CPR and Emergency Cardiovascular Care.”

“Commotio cordis is an extremely rare consequence of blunt trauma to the chest of the appropriate type and intensity at exactly the wrong heartbeat timing,” said Gordon F. Tomaselli, MD, FAHA, former volunteer chair of the American Heart Association. (2011-12) and Dean of Marilyn and Stanley M. Katz at Albert Einstein College of Medicine in the Bronx. “These are several extraordinary things that must all happen at exactly the same time, at the wrong time, within a 20 to 40 millisecond window of the second half of a heartbeat, when the lower chambers of the heart are preparing to contract. . Collapse occurs within seconds.

Tomaselli is an internationally renowned physician-scientist in the field of cardiovascular disease and a cardiac electrophysiologist specializing in sudden cardiac death and cardiac arrhythmias. His research on the regulation of electrical activity in the heart has led to breakthrough therapies that prevent life-threatening heart disorders.

Blunt force impact is usually sustained by a hard spherical object such as a baseball, hockey puck, lacrosse ball, or softball, and can affect anyone who plays physical contact sports. Commotio cordis occurs mainly in boys and young men (average age 15), usually during sports, often despite wearing a chest protector.

Commotio cordis is a specific type of cardiac arrest that can affect anyone who plays physical contact sports. A recent review of the National Commotio Cordis Registry found that commotio cordis can also occur as a result of blunt force trauma to the chest during non-athletic activities, such as assault, car accident, or activities daily. Of the 334 cases of commotio cordis identified between 1980 and 2022, 121 (36%) occurred in non-sporting activities and 213 (64%) in a sporting activity.

Every day, the human heart can beat between 86,400 and 144,000 times (assuming an average of 60 to 100 beats per minute over a 24-hour period), and each heartbeat lasts an average of 0.8 seconds. For commotio cordis to occur, the heart must be struck with blunt force during a specific window of 20 to 40 milliseconds of a heartbeat, as the lower chambers of the heart are about to contract, producing a disturbance potentially deadly heart rate. An electrical shock to the heart from an AED is needed to bring the heart back to a normal rhythm.

With rapid CPR and defibrillation, survival and recovery rates after a commotio cordis episode are greater than 50%.

“If there’s one lesson we can all learn, it’s that the best way to help someone survive a heart emergency, including commotio cordis, is for as many of us as possible. learn CPR; and for each of us to be ready and able to respond to a cardiac emergency that can happen literally anywhere,” Tomaselli said. “Starting the chain of survival steps immediately – calling 911, rapid CPR and defibrillation – these are critical to saving someone’s life, and they must begin within seconds and minutes of the collapse of the ‘individual. Commotio cordis is an extremely rare event, but if it occurs during a sporting event with ready access to emergency care personnel and trained AEDs, and CPR and defibrillation begin quickly, the survival rate is now quite good – over 50% – which is a big improvement from the sub-10% survival rate for most out-of-hospital cardiac arrests. And, in most cases, the affected person is able to resume their previous life and activities.

He added: “We need to focus on the first few minutes after a commotio cordis or sudden cardiac arrest, whatever the cause, because those are the most critical – every minute without the heart beating and the lungs not receiving oxygen equates to a 10% potential loss of function and 10% less chance of survival. We have 10 minutes to save a life.

Nancy Brown, CEO of the American Heart Association, said: “We are delighted that it appears Damar Hamlin will make a full recovery. If there is a greater good that can come from his commotio cordis event, it is that as many people as possible are now aware of the importance of providing emergency care for all cardiac emergencies – all those watching that night saw the Chain of Survival in action, successfully performed. Calling 911, and prompt CPR and defibrillation are essential to saving a person’s life and ensuring optimal recovery. We urge that at least one person in every household learn CPR and be ready to act as soon as they witness a cardiac emergency.

According to American Heart Association 2023 Statistical Updateover 350,000 people in the US experience sudden cardiac arrest outside a hospital. About 90% of people who have a cardiac arrest outside of hospital die, which means only about 1 in 10 people survive. Each year, up to 23,000 people under the age of 18 experience sudden cardiac arrest outside of hospital. It’s the leading cause of death among student-athletes, and sports-related sudden cardiac arrest accounts for nearly 40% of sudden cardiac arrests in under-18s.

About 70% of cardiac arrests occur in non-hospitalized private homes and residences (out-of-hospital cardiac arrest). Therefore, a friend or family member is usually the person to act. CPR, especially if performed immediately, can double or triple a victim’s chances of survival from cardiac arrest.

The American Heart Association has long advocated for public policies at the federal, state, and community levels that encourage the development of cardiac emergency response plans, increase education and training in CPR and AED, and strengthen health care systems. care. Last month, the AHA joined the National Football League in announcing the launch of The Heart Smart Sports Coalition with the NFL, NBA, MLB, MLS, NHL, NCAA, American Red Cross, Korey Stringer Institute, National Athletic Trainers’ Association and Damar Hamlin’s Chasing M’s Foundation. These and other public policies can prevent deaths from sudden cardiac arrest and should be implemented nationwide.

Resources for learning CPR, information on AEDs

For adults and teenagers, Hands-Only CPR is an easy-to-learn skill that requires just two steps: call 911 and push hard and fast into the center of the chest at a rate of 100 to 120 beats per minute. You can find a CPR class near you at heart.org/findacourse. For more information on CPR, visit cpr.heart.org.

AEDs are lifesaving devices and most AEDs prompt the user with verbal instructions for each of the steps in using the device. More information on AED use and training is available here.

About the American Heart Association

The American Heart Association is an unrelenting force for a world of longer, healthier lives. We are committed to equitable health in all communities. Through collaboration with many organizations and millions of volunteers, we fund innovative research, advocate for public health and share vital resources. The Dallas-based organization has been a leading source of health information for nearly a century. Join us on heart.org, Facebook, Twitteror by calling 1-800-AHA-USA1.