Cardio Case Challenge: A 17-Year-Old in Cardiac Arrest After Collision Playing Sports

Jansen Tiongson, MD; Lisa Chan, MD


December 16, 2022

Regardless of the cause, if a young athlete goes into sudden cardiac arrest, CPR should be implemented immediately. Among sports-related cases of commotio cordis documented in the USCCR, 15% of patients survived. When CPR was instituted within 3 minutes of the impact, 68% of patients survived; however, if CPR was delayed by more than 3 minutes, only 3% of patients survived. Animal studies have shown that CPR instituted within the first 3 minutes of injury can increase survival rate by up to 25%. Concomitantly, early use of an automatic external defibrillator (AED) device has been proven to increase survival rates. With an AED recognizing ventricular fibrillation at a sensitivity of 98% and a specificity of 100%, defibrillation within the first 3 minutes can increase the survival rate by an additional 50% or more in animal models, yielding a survival rate of 46% at 4 minutes and 25% at 6 minutes. The USCCR has recommended that all athletic venues have an accessible AED. Preventive measures for commotio cordis include parental education, softer baseballs, and protective padding of an athlete's precordium.[1,4] Secondary prevention may involve avoidance of certain sports until at least age 18 years.

While the patient in this case was in the PICU, he was placed on continuous cardiac monitoring for 24 hours, and no incident of arrhythmia was noted. An echocardiogram revealed a normal left ventricular systolic ejection fraction, with no structural abnormalities, valvular disease, or hypertrophy. A repeat 12-lead ECG showed no changes from the previous one, and subsequently, the serial troponin measurements decreased from 0.25 to 0.04 ng/mL. A pediatric cardiologist consultation was unrevealing. The patient was transferred to the pediatric floor the next day, and he was discharged 2 days after initial admission, with no signs of postarrest sequelae. His final diagnosis was commotio cordis.


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