Health & Science

Rare combination of factors likely led to Damar Hamlin’s on-field cardiac arrest, Houston heart doctor says

The Buffalo Bills player collapsed on the field Monday night. A condition known as Commotio Cordis is in essence a disrupted heartbeat that can be fatal if it’s not treated immediately.

FILE - Buffalo Bills defensive back Damar Hamlin (3) leaves the field after an NFL football game against the New England Patriots, Thursday, Dec. 1, 2022, in Foxborough, Mass. Hamlin was in critical condition early Tuesday, Jan. 3, 2023, after the Bills say his heart stopped following a tackle during the Monday Night Football game, which was indefinitely postponed.
(AP Photo/Greg M. Cooper, File)
FILE – Buffalo Bills defensive back Damar Hamlin (3) leaves the field after an NFL football game against the New England Patriots, Thursday, Dec. 1, 2022, in Foxborough, Mass. Hamlin was in critical condition early Tuesday, Jan. 3, 2023, after the Bills say his heart stopped following a tackle during the Monday Night Football game, which was indefinitely postponed.

A Houston heart doctor is reassuring the parents of young athletes that they will likely never have to face what happened to Buffalo Bills safety Damar Hamlin Monday night in a game against the Bengals in Cincinnati. Hamlin went into cardiac arrest after tackling a Bengals player.

"This is a rare occurrence and it happens when there is blunt trauma that is quite fast and forceful," Houston Methodist Hospital Chief of Cardiology Dr. William Zoghbi said.

The condition is known as Commotio Cordis, which can cause ventricular fibrillation in the heart, in essence a disrupted heartbeat that can be fatal if it's not treated immediately. In Hamlin's case, medical personnel on the sidelines were able to quickly administer CPR and use a defibrillator that shocked his heart back into proper rhythm.

Although it doesn't happen very often to athletes, there are cases of Commotio Cordis reported every year. According to the National Library of Medicine, around 30 cases happen annually, mostly in young athletes who are struck in the chest by hard objects.

"Even in the early 1900s it has been reported in baseball where you have a very fast baseball going and it may hit somebody in the chest," Dr. Zoghbi said. "It is rare, but it has been reported in baseball and hockey. Less in football."

Buffalo Bills safety Damar Hamlin (3) lies on the turf after making a tackle on Cincinnati Bengals wide receiver Tee Higgins, blocked from view, as Buffalo Bills linebacker Tremaine Edmunds (49) assists at the end of the play during the first half of an NFL football game between the Cincinnati Bengals and the Buffalo Bills, Monday, Jan. 2, 2023, in Cincinnati. After getting up from the play, Hamlin collapsed and was administered CPR on the field.
(AP Photo/Joshua A. Bickel)
Buffalo Bills safety Damar Hamlin (3) lies on the turf after making a tackle on Cincinnati Bengals wide receiver Tee Higgins, blocked from view, as Buffalo Bills linebacker Tremaine Edmunds (49) assists at the end of the play during the first half of an NFL football game between the Cincinnati Bengals and the Buffalo Bills, Monday, Jan. 2, 2023, in Cincinnati. After getting up from the play, Hamlin collapsed and was administered CPR on the field.

The blow can disrupt a key electrical current in the heart, but has to be perfectly timed to cause the dangerous ventricular fibrillation where the lower heart chambers pump in an erratic manner and don't allow blood to be pumped to other parts of the body. In Hamlin's case, he stood up after the tackle, but almost immediately lost consciousness and fell backward.

Dr. Zoghbi is confident the vast majority of young athletes won't ever be affected by Commotio Cordis, mostly because of protective sports equipment and factors that have to fall exactly into place to have it occur.

"Sports are occurring every day and most of them really do not involve major, major, very hard blunt trauma to the chest," Dr. Zoghbi said. "Yes, we can have a discussion about that, but you have to balance the rarity with the sport itself and what you can do with the sport with some protection that you may have."

The governing body of high school sports in Texas requires member schools to have at least one automated external defibrillator (AED) on campus and at sports practices and games. The University Interscholastic League (UIL) enacted the policy after a high school football player in Austin went into cardiac arrest during a game in 2006. Many larger schools in Texas now have multiple AED's on campus and on the sidelines during games.

As Damar Hamlin recovers in an Ohio hospital, Dr. Zoghbi says he's fortunate NFL teams are ready with life-saving equipment at games.

"It's so crucial and so important and laudable because you need such attention immediately," Dr. Zoghbi said. "The treatment in this situation is both, one, CPR and two, a cardioversion to get the rhythm of the heart back to normal."

Cardioversion is an emergency procedure that administers a series of rapid, low-energy shocks to the heart.

Hamlin remains in the intensive care unit at the University of Cincinnati Medical Center, which is just minutes away from where the incident happened during Monday night's game between the Bills and Bengals.