Leveling the Playing Field: Making it Heart Safe for Everyone
During a NFL Monday Night Football game, at the start of a brand new Year, Damar Hamlin, a safety for the Buffalo Bills, tackled Bengal’s wide receiver Tee Higgins. Mr. Hamlin stood up momentarily and then collapsed while millions of people watched. The medical response was textbook. Within moments CPR was started and the AED (automatic external defibrillator) pads were applied. The AED read ventricular fibrillation, a deadly rhythm abnormality incompatible with life. Buffalo Bills player number 3 was having a cardiac arrest. The stadium fell silent. Players were on their knees. The defibrillator delivered a shock and normal sinus rhythm was restored. Why had Mr. Hamlin gone into V-fib? There are several reasons why a seemingly healthy person can go into an abnormal rhythm but the cause in this case a strong possibility was commotio cordis, a deadly rhythm induced by blunt force trauma to the chest wall. The New England Journal of Medicine published a disturbing but fascinating research article on this subject in their June 18, 1998 volume. Using an experimental model, scientists concluded that when the chest wall was struck during the “T wave,” ventricular fibrillation was induced. When the chest wall was struck during the “QRS complex,” transient heart block occurred. The EKG alphabet soup of explanations is as follows: the sinus node (a group of pacemaker cells) sends a signal for the heart to beat. On an EKG that is seen as the P wave. The QRS complex on an EKG is coincident with the ventricles (pumping chambers) of the heart receiving the signal that it is time to squeeze the blood out of the heart. The T wave then occurs and is the time when the heart relaxes and gets ready for the next beat. When defibrillator pads are applied to the unconscious patient, it reads the EKG and will advise if a shock is required. This shock is typically 150 Joules of electrical energy delivered through those same pads during the QRS complex, or systole. While commotion cordis is not extremely common, with approximately 30 cases reported per year, it is one of the causes of sudden cardiac death (SCD).
A few days later from his hospital bed, Mr. Hamlin was tweeting about his regret that he was unable to be on the field with his team but that “God was using him in a different way today.” Now, I don’t know the mind of God, but I can’t help believing that good things can and do arise from bad events. I’ve seen it too often not to know on a visceral level that it is true. And I also can’t help believing that as a result of Damar Hamlin’s cardiac arrest, millions of people now know that CPR and AEDs save lives. The Buffalo Bills’ medical team had a cardiac emergency response plan (CERP) and they executed it flawlessly. As the Bills said in a recent statement, “We encourage all our fans to continue showing your support and take the next step by obtaining CPR certification. The Buffalo Bills are dedicated to providing support for those resources; CPR certifications, AED units, and developing cardiac emergency response plans within our community.” Whether you are a Bills fan, or a football fan (or a hockey fan like me), or just love your friends and neighbors, please take the time to get trained in CPR and AED skills. Project ADAM is here to help in any way that we can. Please peruse our website for resources and do not hesitate to contact us. On behalf of the Project ADAM team, we would love for you to join us in honoring Adam’s legacy by learning CPR, and being aware of the location of the AED when you are in a public place, be it a sporting event or school, a place of worship or a park. In your own community you can encourage practice drills so that in case of such an emergency, those present will feel comfortable having rehearsed the plan beforehand and are ready to confidently respond. We hope that you will never need to apply the knowledge that you will gain but if you do, you too can save a life.
Christa Miliaresis, MD, FAAP, FACC
NYMC Department of Pediatrics, Maria Fareri Children's Hospital, Medical Director, New York Affiliate of Project ADAM