NCAA, NATA host productive summit on rare sudden death condition

From: The NCAA News

Athletes step onto the field with an assumption of risk that they may be injured as part of play. What athletes do not commonly think about is their risk for cardiac arrest. Even though cardiac arrest is not common, it does occur in otherwise healthy athletes.

Representatives from medical, research, and sport organizations convened on Monday August 1 at the NCAA to discuss a serious phenomenon that results in cardiac arrest in athletes: commotio cordis. The condition of commotio cordis, also known as cardiac contusion, occurs when a blunt but often relatively mild blow to the chest caused by, but not limited to, a ball, puck, helmet, elbow or knee. Sports in which commotio cordis has recently occurred were identified as baseball, ice hockey, lacrosse and football, although it occurs in other sports, as well. Male athletes have been documented to have a higher incidence. One of the representatives, Mr. Steve Stenersen, executive director of US Lacrosse, offered a statement that was the theme of the conference: Commotio cordis, although uncommon, is an issue that requires greater research and awareness.

Several themes arose from the summit. These include: prevention is a shared responsibility of all persons participating in, or associated with, an organized sports program. Taking steps to reduce the risk of injury during athletic competition can start with proper instruction, fair play and the enforcement of current rules.

• Coaches should appropriately warn student-athletes about the sport’s inherent risks of injury and instruct them how to minimize such risks while participating. Prohibiting athletes from blocking shots and wearing proper equipment are important first steps to reducing the risk of commotio cordis.

• Student-athletes should fully understand and comply with the rules and standard of play that govern that sport. Actions that involve trying to block shots, spearing, high sticks, and unsportsmanlike conduct should be avoided.

• Officials should strictly and consistently enforce any rule prohibiting such actions as noted.

It was noted that there are no screenings or predisposing factors that would lead one to believe this condition may occur since the mechanism is related to being struck by a blunt object. Participants noted that despite wearing chest protectors, some episodes of commotio cordis will still occur despite best efforts in prevention and care.

Other themes from the summit pointed out that sudden death in athletes may not be completely preventable, but an emphasis on proper emergency recognition can lead to rapid response and appropriate care in situations involving a downed athlete. Summit participants emphasized the critical role of emergency care recognition of a downed athlete and recommended regular clinical practice of an emergency response plan to cardiac arrest to be included with the more commonly practiced response to head and spine injuries in sports.

The NCAA Sports Medicine Handbook outlines guidelines for its member institutions on emergency care and continues to emphasize the need for coaches to obtain cardiopulmonary resuscitation (CPR) certification. Access to early defibrillation was recently added to the guidelines outlined in the 2005-2006 handbook. "Through my research I have found that approximately 80 % or more NCAA Athletics Departments have access to AED’s at selected areas on campus," said Dr. Jonathan Drezner, University of Washington. Dr. Douglas Zipes, director of cardiology at Indiana University, added that he would like to see an AED in every high school across the country.

Among the ideas that were generated at the summit on Monday, some will lend themselves to multi-organizational action. These include:

• Facilitate widespread understanding and recognition of commotio cordis in sports.
• Facilitate the development of a coordinated integrated registry system for sudden death and catastrophic injury.
• Encourage collaborative efforts among researchers, sports organizations, and product manufacturers to enhance the validity and reliability of the production of sports protective equipment.

Available on-line at: http://www2.ncaa.org/media_and_events/association_news/association_updates/2005/august/0808_nata.html.

Published on August 8, 2005