Commotio Cordis in Non–Sport-Related Events: A Systematic Review

Abstract

BackgroundCommotio cordis is an increasingly recognized cause of sudden cardiac death. Although commonly linked with athletes, many events occur in non–sport-related settings. ObjectivesThe goal of this study was to characterize and compare non–sport-related vs sport-related commotio cordis. MethodsPubMed and Embase were searched for all cases of commotio cordis from inception to January 5, 2022. ResultsOf 334 commotio cordis cases identified, 121 (36%) occurred in non–sport-related contexts, which included assault (76%), motor vehicle accidents (7%), and daily activities (16%). Projectiles were implicated significantly less in non–sport-related events (5% vs 94%, respectively; P < 0.001). Nonprojectile etiologies in non–sport-related events mostly consisted of impacts with body parts (79%). Both categories affected similar younger aged demographic (P = 0.10). The proportion of female victims was significantly higher in non–sport-related events (13% vs 2%, respectively; P = 0.025). Mortality was significantly higher in non–sport-related events (88% vs 66%, respectively; P < 0.001). In non–sport-related events, rates of cardiopulmonary resuscitation (27% vs 97%, respectively; P < 0.001) and defibrillation (17% vs 81%, respectively; P < 0.001) were both lower and resuscitation was more commonly delayed beyond 3 min (80% vs 5%, respectively; P < 0.001). ConclusionsCommotio cordis occurs across a spectrum of non–sport-related settings including assault, motor vehicle accidents, and daily activities. Both categories affected a younger and male-predominant demographic. Mortality is higher in non–sport-related commotio cordis, likely owing to lower rates of cardiopulmonary resuscitation, defibrillation, automated external defibrillator availability, and extended time to resuscitation. Increased awareness of non–sport-related commotio cordis is essential to develop a means of prevention and mortality reduction, with earlier recognition and prompt resuscitation measures.