What is Commotio Cordis?

Commotio Cordis is an episode of ventricular fibrillation (VF) induced by a sudden blunt trauma to the chest. A direct blow to the chest from a baseball, hockey puck, or a collision with another player or a stationary object typically causes this condition. For VF to occur, the blow must happen at a precise millisecond of the heart’s electrical cycle. This phenomenon has been observed in humans and is well documented in laboratory animals.

When the blow to the chest occurs at this precise moment in the heart’s cycle, the heart will “fibrillate.” The blow usually causes no identifiable structural injury to the ribs, sternum, or the heart itself.  After the impact, the athlete will typically stumble forward for a few seconds, which is followed by unconsciousness, no breathing, and no pulse.

Who is at risk of Commotio Cordis?

The data on recorded events for Commotio Cordis shows that adolescent males are at the highest risk.  In the national registry for Commotio Cordis, the mean age for those suffering from this phenomenon is 15 years.  Additionally, the data shows that baseball has the highest number of recorded cases of Commotio Cordis for organized sports (although there are also events in lacrosse, hockey, football, and other sports).  But why?  It is believed that males are at a higher risk than females due to the composition of the chest wall during the early teen years and, coincidentally, the speed typically seen for a baseball during game play in the early teen years corresponds to the amount of force needed to cause an event.  Medical researchers have concluded that a baseball (or lacrosse ball) traveling at approximately 40 miles per hour generates an amount of force on impact with the chest that is most likely to cause Commotio Cordis.  This alignment of factors helps to explain why baseball sees such a large number of cases.

It is important to note however that ALL baseball players are at risk and the documented events show that very few catchers have suffered from Commotio Cordis.  Pitchers, batters, fielders, and base runners have all experienced documented cases of Commotio Cordis from batted or thrown balls.

Can commotio cordis be treated?

At one point in time, survival rates from commotio cordis were extremely low due to lack of awareness about the condition and poor availability of AED's.  With better education from organizations such as the Louis J. Acompora Foundation and better availability of AED's, survival rates have increased significantly.  When commotio cordis is suspected after an impact to the chest, it is critical that emergency medical personnel are contacted immediately and the nearest AED is located.  For every minute that deployment of an AED is delayed, survival rates decrease by 10%.

What does it mean for a chest protector to be "Certified"? 

The National Operating Committee on Standards for Athletic Equipment (NOCSAE) first created a test standard for determining whether a chest protector would be effective at reducing the risk of commotio cordis in 2017 based on available medical research.  In order to be certified to the NOCSAE standard, a piece of equipment must be independently tested at a certified lab to this standard, and then the Safety Equipment Institute (SEI) certifies that not only the equipment has passed testing, but that the manufacturer has a management and quality system in place to ensure repeatable compliance to the standard over the course of manufacturing.  All-Star was the first manufacturer to have chest protectors certified by SEI to the NOCSAE standard and continues to be an industry leader in availability of a full range of sizes and colors of these products.

While NOCSAE has created this test for the effectiveness of chest protectors in reducing the risk of commotio cordis that is being broadly applied to catcher's chest protectors, this standard can also be applied to protectors for all players and All-Star was the first company to have a fielder's protector certified to the NOCSAE standard.

Is my child required to wear a certified chest protector?

At this time, the only known requirement for use of certified chest protectors is in US high school play for schools governed by the National Federation of High Schools (NFHS).  If your school plays under NFHS rules, any baseball player who catches will be required to wear a chest protector certified to the NOCSAE standard effective January 1, 2020.  Additionally, the National Collegiate Athletic Association (NCAA) has announced that all baseball catchers in all divisions (I, II, and III) will have to wear a chest protector certified to the NOCSAE standard effective January 1, 2021.

Beyond those listed above, there are no other known leagues that have plans in place to require certified chest protectors.  We continue to monitor other leagues for announcements and will include them here when they occur.