Abstract 19706: Increasing Survival and Decreasing Sudden Death Rate from Commotio Cordis

Abstract

Introduction. Commotio cordis events due to precordial blows triggering ventricular fibrillation are a cause of sudden death (SD) in competitive and recreational sports and normal daily activities. Despite normal cardiac structure, these events have been considered predominantly fatal with survival rates of < 20%. Hypothesis. To determine whether there has been a change in the expected mortality rate for commotio cordis over time, associated with (or due to) greater public visibility of this condition. Methods. U.S. Commotio Cordis Registry was accessed to tabulate the frequency of resuscitated cardiac arrest or SD from 1970 to 2012. Results. At the time of their commotio cordis event, 215 study patients were 1 to 50 years old, mean 15; 95% were male. Death due to commotio cordis occurred in 156 individuals (73%), and the other 59 (27%) survived. Notably, the proportion of commotio cordis survivors increased steadily with a concomitant decrease in fatal events over 43 years: for the first 24 years (1970-1993) only 6 of 59 survived (10%) while in the most recent 19 years (1994-2012), 53/156 (34%) survived (p < 0.001). From 2006-2012, survival was 30/52 (58%), at which point the survivor and non-survivor curves crossed (Figure). Survival from commotio cordis was lower in African-Americans (1/24; 4%) compared to whites (53/165; 32%; p=0.007), and less common in recreational sports (16%)/daily activities (12%) than during competitive sports (39%; p < 0.001). Multivariate analysis showed adverse independent predictors of survival to be black race (p=0.051), recreational sports (p=0.019), and daily activities (p=0.012), while the onsite use of AEDs was protective vs. SD (p=0.006). Conclusions. Survival from commotio cordis has become significantly more common, largely due to public access defibrillation and greater public awareness. Racial disparity in survival is a notable concern.