American Heart Association Journals
February 23, 2024
Abstract
BACKGROUND:
Commotio cordis, sudden cardiac death (SCD) caused by relatively innocent impact to the chest, is one
of the leading causes of SCD in sports. Commercial chest protectors have not been demonstrated to
mitigate the risk of these SCDs.
METHODS:
To develop a standard to assess chest protectors, 4 phases occurred. A physiological commotio cordis
model was utilized to assess variables that predicted for SCD. Next, a surrogate model was developed
based on data from the physiological model, and the attenuation in risk was assessed. In the third
phase, this model was calibrated and validated. Finally, National Operating Committee on Standards for
Athletic Equipment adopted the standard and had an open review process with revision of the standard
over 3 years.
RESULTS:
Of all variables, impact force was the most robust at predicting SCD. Chest wall protectors which could
reduce the force of impact to under thresholds were predicted to reduce the risk of SCD. The correlation
between the experimental model and the mechanical surrogate ranged from 0.783 with a lacrosse ball
at 30 mph to 0.898 with a baseball at 50 mph. The standard was licensed to National Operating
Committee on Standards for Athletic Equipment which initially adopted the standard in January 2018,
and finalized in July 2021.
CONCLUSIONS:
An effective mechanical surrogate based on physiological data from a well-established model of
commotio cordis predicts the reduction in SCD with chest protectors. A greater reduction in force
provides a great degree of protection from commotio cordis. This new National Operating Committee
on Standards for Athletic Equipment standard for chest protectors should result in a significant
reduction in the risk of commotio cordis on the playing field.