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Commotio Cordis in Non-Sport-Related Events: A Systematic Review
Rafael N Lee1, Thalys Sampaio Rodrigues2, Joscelyn T Gan1
1University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Victoria, Australia; Austin Health, Melbourne, Victoria, Australia.
Insights
Commotio cordis, a cause of sudden cardiac death, occurs in both sports and non-sport settings. Non-sport events, often due to assault, have higher mortality rates and delayed resuscitation compared to sports-related incidents.
Area of Science:
- Cardiology
- Sudden Cardiac Death
- Trauma Medicine
Background:
- Commotio cordis is an increasingly recognized cause of sudden cardiac death (SCD).
- While often associated with athletes, many commotio cordis events occur in non-sport-related settings.
- Understanding the differences between sport-related and non-sport-related commotio cordis is crucial for prevention and treatment.
Conclusions:
- Commotio cordis occurs in diverse non-sport settings, including assault and motor vehicle accidents.
- Higher mortality in non-sport commotio cordis is linked to lower rates of CPR, defibrillation, and delayed resuscitation.
- Increased awareness and prompt resuscitation are essential for preventing mortality in non-sport-related commotio cordis.
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.
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