Do they protect against heart failure?

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Sports medicine specialist Dr. Kody Moffatt knows how watching Damar Hamlin collapse from cardiac arrest on «Monday Night Football» has scared parents of young athletes.

«Almost every family I’ve seen in the clinic since Tuesday morning has asked about this,» said Moffatt, division chief of sports medicine at Children’s Hospital & Medical Center in Omaha, Nebraska. «They were concerned about the impacts to the chest.»

Such life-threatening injuries are extremely rare, and while it now appears the 24-year-old Buffalo Bills safety is on the mend, the incident was a reminder of how quickly injuries can happen.

Doctors at the University of Cincinnati Medical Center have not announced what exactly caused Hamlin’s cardiac arrest, the sudden loss of heart function, but during a news conference Thursday they did not rule out a phenomenon called commotio cordis.

Commotio cordis occurs when a projectile, often a hockey puck or baseball, for example, strikes a person’s chest, throwing the heart’s electrical system out of whack. The person goes into life-threatening cardiac arrest.

Immediate CPR and an automated external defibrillator (AED) are critical in the moments that follow, and that’s how Damar Hamlin survived, experts said.

«The quick response is what saved this player’s life,» said Dr. William Roberts, a sports medicine specialist at the University of Minnesota.

Commotio cordis occurs less than a few dozen times a year in the US Can chest protectors prevent the problem? With pads costing up to $100 or more, is it worth it?

«When it comes to your child, it’s not uncommon,» said Karen Acompora, chair of the board of Parent Heart Watch, a group that advocates for greater heart protection in youth sports.

Louis Acompora died at age 14 after a commotio cordis during a lacrosse game.Courtesy of Karen Acompora

Acompora’s son, Louis, was playing his first high school lacrosse game on Long Island, New York, in 2000, when a blow to the chest caused a commotio cordis. CPR was administered, but there was no AED at the scene.

Louis was only 14 years old when he died. His mother has been pushing for chest protection in youth sports ever since.

«I don’t understand why youth sports don’t jump over security before a problem occurs,» Acompora said.

It was not until 2019 that the National Operating Committee for Sports Equipment Standards developed standards for chest protectors.

In 2022, united states lacrosse mandated that all youth lacrosse players wear chest protection.

Although doctors haven’t said whether Hamlin’s injury was truly a commotio cordis, Acompora is happy to see the condition receiving national attention.

«I hope with this latest incident that people open their eyes and say, hmm, maybe we need to do something.»

There are mixed opinions about chest protection in youth sports.

A study 2017 led by Tufts Medical Center in Boston found that chest protectors, specifically those incorporating Kevlar, can «be effective in preventing commotio cordis on the field of play.»

Stephens, who was not involved in the Tufts study, explained that Kevlar works by spreading the energy of an impact, rather than allowing a projectile to concentrate all of its force in one place.

But the study was done with pigs, not humans. That’s not enough scientific evidence to support the use of chest protectors in youth sports, said Dr. Matthew Silvis, director of sports medicine at Penn State Health.

Silvis was concerned that a chest protector might give a false sense of security.

«What you don’t want is someone wearing a chest protector to think, well, I’m protected from this injury and now I can play a little more reckless,» Silvis said.

Until Monday night’s NFL game, Dr. Chad Stephens, a sports medicine and interventional pain specialist in private practice near Dallas, had recommended chest pads only for high school sports like baseball and lacrosse, in those where commotio cordis is most common.

Chest protectors like this one from Unequal Technologies have been in demand since Damar Hamlin's cardiac arrest on Monday.
Chest protectors like this one from Unequal Technologies have been in demand since Damar Hamlin’s cardiac arrest on Monday.Courtesy of Unequal Technologies

«I wasn’t a proponent of players having a chest pad for non-projectile sports,» Stephens said. «He was not so convinced that something like this could happen» in football. This is making me rethink my whole stance.»

Rob Vito, CEO and founder of Unequal Technologies, said his phone has been ringing off the hook with calls from coaches, players and parents.

The company makes chest pads that include Kevlar, the same material used in bulletproof vests.

«We’re getting calls from soccer moms and baseball dads,» Vito said. «All the sports are getting closer.»

Can commotio cordis be prevented?

Instead of investing in protective chest gear, Silvis of Penn State Health advises coaches to teach their young players proper technique when facing an oncoming hockey ball or puck.

Players must learn to turn their body as much to the side as possible in these cases, with the goal of avoiding a chest collision.

The best way to prevent children from dying of cardiac arrest on the field is to make sure coaches and players know CPR and have quick access to AEDs, said Roberts of the University of Minnesota.

«If we look at the risk reduction of adding a chest plate, compared to the risk reduction of training everyone in hands-only CPR with an AED available at sites, it would largely fall on CPR and AEDs in terms of of lives saved,» said Roberts, affiliated with the National Academy of Sports Medicine.

Instead of parents buying a chest protector, «how do we make sure that our coaches and the people that are at these games are trained in CPR?» Silvis asked.

There was widespread agreement that AEDs are necessary at all sporting events, not just for players but also for coaches, parents, grandparents, and other game watchers.

Despite the lack of data showing that chest pads always protect against commotio cordis, young athletes who play baseball, hockey and lacrosse may want to consider them, Moffatt said.

«There is little harm and there certainly could be significant benefit,» Moffatt said. «As a parent and as a doctor, I like to do things to protect my children.»

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