Damar Hamlin collapse: What is commotio cordis?

Buffalo Bills safety Damar Hamlin suffered cardiac arrest following a tackle in a game against the Cincinnati Bengals on Monday night.

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Hamlin, 24, collapsed moments after he tackled Bengals’ receiver Tee Higgins after Higgins made a 13-yard catch. It appeared Higgins and Hamlin collided at Hamlin’s head and chest area.

Following the hit, Hamlin quickly stood up, took two steps, then collapsed backward onto the field. His body appeared limp.

Medical personnel were called to the field and quickly began to administer CPR. WXIX-TV in Cincinnati reported that Hamlin required the help of an automated external defibrillator (AED) in addition to CPR while on the field. Hamlin was then taken to the University of Cincinnati Medical Center.

The Buffalo Bills tweeted early Tuesday that Hamlin went into cardiac arrest after the hit.

“His heartbeat was restored on the field,” the team tweeted. “He is currently sedated and listed in critical condition.”

While it’s important to note that neither the hospital nor the Bills organization has confirmed the cause of Hamlin’s collapse, speculation has turned to a mostly obscure condition, called “commotio cordis.”

What is commotio cordis and is it life-threatening?

Commotio cordis can occur after a person suffers a blow to the chest during a specific point in the heart’s rhythm. While Hamlin was hit during a professional football game, the blow does not have to be particularly hard for it to cause the heart to stop.

Commotio cordis most commonly results from an impact to the left portion of the chest and is seen most often during sporting events. It can happen when a person is hit with a hard object, like a baseball or a hockey puck, which is made of vulcanized rubber -- or even a punch or kick in martial arts.

Three factors determine the likelihood of suffering commotio cordis: the direction of the impact over the heart area; how hard the blow is; and at what point in the heart’s rhythmic cycle the blow comes.

According to researchers, the blow generally does not cause damage to the heart but does cause ventricular fibrillation, which is a type of irregular heart rhythm that causes sudden cardiac arrest, meaning the heart has stopped beating.

The blow must come at the right moment in the heart’s rhythmic cycle, basically at the end of one beat and the beginning of the next, to cause the condition.

The prognosis for those who have suffered commotio cordis is poor, though it is somewhat better if defibrillation can be performed within 3 minutes after the incident.

Hamlin was attended to within 10 seconds of his injury. It is not clear when he was defibrillated.

Commotio cordis is rare, with fewer than 30 incidents reported each year in the US.

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