Sudden death in children due to the impact of a Commotio Cordis balloon

We have decided to open this post because some students tell us that they have heard about a player who died of a bullet in the chest.

Definition: Commotio cordis.

Commotio cordis is an actual or near-stop cardiac arrest due to a blunt impact on the chest wall at the level of the heart. A blow to the chest during the vulnerable phase of the cardiac cycle can cause malignant arrhythmias (and often, fibrillation). ventricular).

What exactly happens in the heart when it receives an impact?

The commotio cordis happens when there is a sharp blow with an object in the chest wall, a blow that falls exactly in a window of about twenty milliseconds that has the cardiac cycle, which is what we call the vulnerable window (see infographic). When there is a blow that causes electrical activation just in that window, the heart can enter ventricular fibrillation that is the prelude to sudden death because it is a chaotic heart rhythm that does not allow the heart to keep beating and circulating the blood. This is extremely rare in sports like football, is more common in sports that are played with heavy round objects such as hockey or baseball.

Children and youth

The commotio cordis takes place mainly in the practice of sports and leisure activities; the victims are usually young men (14 years on average). The overall survival rate is 15%, but it goes up to 25% if resuscitation starts within the next 3 minutes.

In a review recently published in the 'New England Journal of Medicine', 224 analyzed cases of ventricular fibrillations caused by a blow to the chest without traumatic damage, during the last 15 years. In the review it is found that the 75% of the cases take place during youth sports activities and leisure activities with friends or family.

Basic life support and use of the automatic defibrillator.

The data recorded from 2002 to the present have shown a very important increase in survival associated with a greater expansion of external automatic defibrillators (AED) in the community; and an increase in the number of people trained in basic life support and use of the defibrillator (DEA), willing to perform cardiopulmonary resuscitation and defibrillation.

Recommendations: Measures must be taken to ensure that the recovery of the victims of commotio cordis is successful, including measures such as due preparation of coaches, referees, etc; to ensure rapid recognition, notification to emergency medical services and immediate establishment of resuscitation and defibrillation maneuvers.

Conclusions: The commotio cordis is an unusual event but at the same time an important cause of morbidity and mortality in youth sports, as well as in many other circumstances. Probably, a completely complete prevention will never be reached and, therefore, the most reasonable thing should be to place emphasis on the rapid recognition of the event and establishment of resuscitation and defibrillation measures.

Life-saving bracelets: get defibrillator and training without cost.

From Project Salvavavidas we put at your disposal the life-saving bracelets so that sports centers can acquire the defibrillator and staff training at no cost to the institution.

Numerous sports centers have gained access to early defibrillation and resuscitation training using life-saving bracelets. For more information call the 911 250 500 free or contact us by email This e-mail address is being protected from spambots. You need JavaScript enabled to view it..


-Spanish Society of Cardiology.

-Maron BJ, Estes NA, 3rd. Commotio cordis. N Engl J Med 2010; 362: 917-27.

-Link MS, Estes M, Maron BJ. Sudden death caused by chest wall trauma (commotio cordis). In: Kohl P, Sachs F, Franz MR, eds. Cardiac Mechano-Electric Feedback and Arrhythmias: From Pipette to Patient. Philadelphia: Elsevier Saunders; 2005: 270-6.

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