Increasing survival rate from commotio cordis

Background Commotio cordis events due to precordial blows triggering ventricular fibrillation are a cause of sudden death (SD) during sports and also daily activities. Despite the absence of structural cardiac abnormalities, these events have been considered predominantly fatal with low survival rates. Objective To determine whether expected mortality rates for commotio cordis have changed over time, associated with greater public visibility. Methods US Commotio Cordis Registry was accessed to tabulate frequency of reported SD or resuscitated cardiac arrest over 4 decades. Results At their commotio cordis event, 216 study patients were 0.2–51 years old (mean age 15±9 years); 95% were males. Death occurred in 156 individuals (72%), while the other 60 (28%) survived. Proportion of survivors increased steadily with concomitant decrease in fatal events. For the initial years (1970–1993), 6 of 59 cases survived (10%), while during 1994–2012, 54 of 157 (34%) survived (P =.001). The most recent 6 years, survival from commotio cordis was 31 of 53 (58%), with survivor and nonsurvivor curves ultimately crossing. Higher survival rates were associated with more prompt resuscitation (40%<3 minutes vs 5%>3 minutes; P<.001) and participation in competitive sports (39% P<.001), but with lower rates in African Americans (1 of 24; 4%) than in whites (54 of 166; 33% P =.004). Independent predictors of mortality were black race (P =.045) and participation in noncompetitive sports (P =.002), with an on-site automated external defibrillator use protective against SD (P =.01). Conclusions Survival from commotio cordis has increased, likely owing to more rapid response times and access to defibrillation, as well as greater public awareness of this condition.