Heart Guard and Commotio Cordis

[MagicDad]

I replied on another thread about masks and I mentioned heart guards and I was asking about any studies relating to them. I remember reading a while ago about them not being worth the time or money. I'm still searching for the artical I once read, but it was talking about how heart trama occurs when there is a low blunt force. It also refered to the fact that heart guards don't work and that they may also inhance the situtation. Now I'm not saying this is right or wrong I was just asking for any new studies.

In trying to find the study I read I came across this one.

Commotio Cordis

Again it's dated 2010

Here's one paragraph:
Experts have suggested using chest protectors, but so far none of the commercially available chest protectors has been shown to work. Until somebody creates a model that actually protects kids, I don't think chest protectors are worth the money or the discomfort to the players.

So if anyone has any other information I would be interested in reading it.

 

[justanotherguy]

I'm wondering how my DD's new setup will work. In the past it was just one of those little padded heart guards. Now, we got her the one where you mold the entire piece across the chest. It covers the entire chest, is HARD with padding as well. It seems to me that this is massively more protective than the little pad that just goes over the heart. I'd LOVE to see some real studies. I'm a motorcycle road racer and things like helmets have levels of certification they can meet and are rigorously tested. DOT certification is a minimum to be considered "road legal". Before we're allowed on the track we have to go through tech where all of our gear is gone over and certain pieces of equipment must have certain levels of certification. While not even remotely as dangerous as racing, it would be nice to have a standard set and certification created for those standards. While I feel my DD's new chest protector will protect her, I simply don't know.

 

[Greenmonsters]

I replied on another thread about masks and I mentioned heart guards and I was asking about any studies relating to them. I remember reading a while ago about them not being worth the time or money. I'm still searching for the artical I once read, but it was talking about how heart trama occurs when there is a low blunt force. It also refered to the fact that heart guards don't work and that they may also inhance the situtation. Now I'm not saying this is right or wrong I was just asking for any new studies.

In trying to find the study I read I came across this one.

Commotio Cordis

Again it's dated 2010

Here's one paragraph:
Experts have suggested using chest protectors, but so far none of the commercially available chest protectors has been shown to work. Until somebody creates a model that actually protects kids, I don't think chest protectors are worth the money or the discomfort to the players.

So if anyone has any other information I would be interested in reading it.

The link you provide is to an internet article provided by an EMT. While I have the utmost respect for EMT's and the first-response care they provide, I would classify the article as an opinion piece promoting CPR training and AED availability, which I support. It is not by any stretch of the imagination a medical study.

 

[PA SB Dad]

This was a thread I started last summer when my team was playing 12U PONY Nationals: http://www.discussfastpitch.com/softball-discussions/15483-i-am-now-true-believer-evoshield.html

There are animal models for blunt force trauma to the chest, but a definitive medical study can never be done. The incidence is too rare. Note though that commotio cordis has occurred to players wearing catchers gear. There is no perfect solution for such a rare and devastating event.

 

[GunnerShotgun]

And his is why none of the manufacturers state that any of their products will protect against commotio cordis. Because they don't.

Wear them for peace of mind and to protect against bumps and bruises but understand what they can and can't do.

 

[YOCOACH]

Found here: State of Florida District Administrators: Announcements

"Heart Injuries / Deaths
According to the U.S. Commotio Cordis Registry, since 1998, one hundred and thirty (130) athletes have died from blunt force injury to the heart (Commotio Cordis). Of those, 70 were children ages 4-18, according to the Heart Center at TUFTS New England Medical Center. In an effort to educate the public about the potential risks physically active youth can face, the National Athletic Trainers’ Association (NATA) Age-Specific Task Force recommends that parents and coaches take proactive steps to protect their athletes against Commotio Cordis. Commotio Cordis is caused by a blow to the chest (directly over the heart) that occurs between heart contractions. The blunt force causes a lethal abnormal heart rhythm. Click on the "Handout" Below for additional Information and an a Brochure from Philips."

 

[YOCOACH]

Commotio Cordis

This was written in 2007 but claims that at that time, CC is becoming more common as an injury and over 180 cases had been reported. It also stated that the number is likely larger due to the lack of training in identifying it.

An excerpt:

Conclusion.

CC is being reported with increasing frequency and young athletes tend to be most at-risk. Sudden cardiac death results from the instantaneous induction of VF following a precordial chest wall blow. A narrow window of vulnerability corresponding to the time of intrinsic increase in repolarization dispersion, just before the peak of the T wave has been identified. In addition, several other variables, including the impact location and the hardness and velocity of the projectile relate to the production of a critical LV pressure that is necessary to induce VF. Rapid LV pressure rise following chest impact results in myocardial stretch and activation of ion channels, including the K+ATP channel, via mechano-electric coupling. Inward current through these mechano-sensitive ion channels results in further augmentation of repolarization and non-uniform myocardial activation, and is the cause of premature ventricular de-polarizations that are the triggers of VF. Survival in the USCCR is quite poor and largely depends on institution of early defibrillation and resuscitation. Increasing the availability of AEDs at organized youth sporting events should enhance the safety of young athletes. In addition, the importance of developing more effective primary prevention strategies for CC - such as effective chest protectors and safety balls - and promoting their widespread use is needed.

At that time, chest protectors were not adequate enough.

Another excerpt:

In the United States, chest protectors are marketed with claims of protecting athletes from chest wall trauma. However, in the USCCR, more than 38% of the fatal impacts occurring during organized sport involved individuals who were wearing a chest protector [3,7]. In several of these cases, migration of the protector exposed the chest to a direct impact. In other cases, however, projectiles were known to strike on the chest protector, which failed to prevent the fatal CC event. Recently, the effectiveness of commercially available lacrosse and baseball chest protectors was assessed for the prevention of sudden cardiac death [19]. None of the currently available chest protectors was shown to significantly decrease the incidence of VF when compared to controls. In accord with our previous findings, peak LV pressure produced by chest wall impacts correlated linearly with the probability of VF in these experiments. Using a 3 rib biomechanical dummy model, Viano et al also demonstrated the ineffectiveness of several commercial chest protectors in reducing the potential risk of CC [20]. The majority of the chest protectors evaluated in these studies were composed of a compliant layer(s) of closed cell foam of varying thickness and density that is intended to dissipate the energy of an impact. The ineffectiveness of this design in reducing the incidence of VF is likely due to its inability to adequately reduce the peak LV pressure generated by chest wall impact. It is clear that further research on the development of an adequate chest protector for the prevention of CC is needed.

It sounds to me as if the testing was mostly done on catching gear chest protectors or similar types such as those worn in Lacrosse. Actual heart guards that I have seen recently are a hard shell plastic with good padding behind it. I wonder if these have ever been tested and how effective they are?

Still, some protection is always better than no protection at all.

 

[coach james]

I'm glad this thread is open. When my dd got hit in the knee while pitching last summer, it made me hypersensitive to protecting my pitchers and corners. We saw first hand just how quickly a ball can come back on you! In addition to her rip it mask, I was looking into the EVOSHIELD razor back shirt with the moldable protective chest guard built in. Does anyone own one of theses? Are the restrictive/comfortable? They cost about $90, and if it saves her from injury, its a small price.

 

[YOCOACH]

The latest study I could find but it is still from 2009 (Commotio cordis and the epidemiology of sudden de... [Pediatrics. 2009] - PubMed - NCBI) and based on the USCCR (United States Commotio Cordis Registry) numbers. Everything else is basically a rehash of the study above from 2007. One thing that I've inferred from all of the articles I've read, the chest protectors that are being talked about and tested are those that the players use as standard equipment such as catching chest protector, lacrosse goalie chest protector, Hockey goalie chest protector. They are NOT talking about the EvoShield or Hard plastic heart guards available today.

 

[Kevin Meyer]

Do you wear a crash helmet in your car? The likelihood of needing one is probably two orders of magnitude greater.