Commotio Cordis in Non-Sport-Related Events: A Systematic Review

Rafael N Lee; Thalys Sampaio Rodrigues; Joscelyn T Gan; Hui-Chen Han; Rama Mikhail; Prashanthan Sanders; Omar Farouque; Han S Lim

doi:10.1016/j.jacep.2023.01.010

Commotio Cordis in Non-Sport-Related Events: A Systematic Review

JACC Clin Electrophysiol. 2023 Aug;9(8 Pt 1):1321-1329. doi: 10.1016/j.jacep.2023.01.010. Epub 2023 Mar 22.

Authors

Rafael N Lee¹, Thalys Sampaio Rodrigues², Joscelyn T Gan¹, Hui-Chen Han¹, Rama Mikhail¹, Prashanthan Sanders³, Omar Farouque¹, Han S Lim⁴

Affiliations

¹ University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Victoria, Australia; Austin Health, Melbourne, Victoria, Australia.
² University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Victoria, Australia; Austin Health, Melbourne, Victoria, Australia. Electronic address: https://twitter.com/drThalysSR.
³ South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia; Royal Adelaide Hospital, Adelaide, South Australia, Australia. Electronic address: https://twitter.com/PrashSanders.
⁴ University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Victoria, Australia; Austin Health, Melbourne, Victoria, Australia. Electronic address: lim.h@unimelb.edu.au.

PMID: 37558288
DOI: 10.1016/j.jacep.2023.01.010

Abstract

Background: Commotio cordis is an increasingly recognized cause of sudden cardiac death. Although commonly linked with athletes, many events occur in non-sport-related settings.

Objectives: The goal of this study was to characterize and compare non-sport-related vs sport-related commotio cordis.

Methods: PubMed and Embase were searched for all cases of commotio cordis from inception to January 5, 2022.

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 (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 min (80% vs 5%, respectively; P < 0.001).

Conclusions: Commotio cordis occurs across a spectrum of non-sport-related settings including assault, motor vehicle accidents, and daily activities. Both categories affected a younger and male-predominant demographic. Mortality is higher in non-sport-related commotio cordis, likely owing to lower rates of cardiopulmonary resuscitation, defibrillation, automated external defibrillator availability, and extended time to resuscitation. Increased awareness of non-sport-related commotio cordis is essential to develop a means of prevention and mortality reduction, with earlier recognition and prompt resuscitation measures.

Keywords: commotio cordis; defibrillation; sudden cardiac death; ventricular fibrillation.

Publication types

Systematic Review

MeSH terms

Aged
Cardiopulmonary Resuscitation*
Commotio Cordis* / complications
Commotio Cordis* / epidemiology
Death, Sudden, Cardiac / epidemiology
Death, Sudden, Cardiac / etiology
Death, Sudden, Cardiac / prevention & control
Defibrillators / adverse effects
Female
Humans
Male