Maron B J, Poliac L C, Kaplan J A, Mueller F O
Cardiovascular Research Division, Minneapolis Heart Institute Foundation, MN 55407-3984, USA.
N Engl J Med. 1995 Aug 10;333(6):337-42. doi: 10.1056/NEJM199508103330602.
Sudden death from cardiac arrest in a young person may occur during sports play after a blunt blow to the chest in the absence of structural cardiovascular disease or traumatic injury (cardiac concussion or commotio cordis). We studied the clinical features of this apparently uncommon but important phenomenon.
We identified cases from the registries of relevant agencies and organizations, as well as newsmedia accounts, and developed a clinical profile of 25 children and young adults, 3 to 19 years of age.
Each victim collapsed with cardiac arrest immediately after an unexpected blow to the chest, which was usually inflicted by a projectile (such as a baseball or hockey puck). Incidents took place during organized competitive sports in 16 cases and in recreational settings at home, at school, or on the playground in 9. In each instance, the impact to the chest was not judged to be extraordinary for the sport involved and did not appear to have sufficient force to cause death. Twelve victims collapsed virtually instantaneously on impact, whereas 13 remained conscious and physically active for a brief time before cardiac arrest. Cardiopulmonary resuscitation was administered within about three minutes to 19 victims, but normal cardiac rhythm could be restored in only 2 (both incurred irreversible brain damage and died shortly thereafter). Seven victims (28 percent) were wearing some form of protective chest padding.
We speculate that most sudden deaths related to impact to the chest (not associated with traumatic injury) are due to ventricular dysrhythmia induced by an abrupt, blunt precordial blow, presumably delivered at an electrically vulnerable phase of ventricular excitability. This profile of blunt chest impact leading to cardiac arrest adds to our understanding of the range of causes of sudden death on the athletic field and may help in the development of preventive measures.
在没有结构性心血管疾病或创伤性损伤（心脏震荡或心脏震荡伤）的情况下，年轻人在胸部受到钝击后进行体育活动时可能会发生心脏骤停导致的猝死。我们研究了这一明显不常见但重要现象的临床特征。
我们从相关机构和组织的登记处以及新闻媒体报道中识别病例，并建立了25名3至19岁儿童和年轻人的临床资料。
每名受害者在胸部意外受到撞击后立即因心脏骤停而倒地，撞击通常由投射物（如棒球或曲棍球）造成。16例事件发生在有组织的竞技体育活动中，9例发生在家庭、学校或操场的娱乐场所。在每种情况下，对胸部的撞击对于所涉及的运动来说都不被认为是异常的，而且似乎没有足够的力量导致死亡。12名受害者在撞击后几乎瞬间倒地，而13名受害者在心脏骤停前仍有意识并能短暂活动。19名受害者在约三分钟内接受了心肺复苏，但只有2人恢复了正常心律（两人均遭受不可逆的脑损伤，随后不久死亡）。7名受害者（28%）穿着某种形式的胸部护垫。
我们推测，大多数与胸部撞击相关的猝死（与创伤性损伤无关）是由于心前区突然受到钝击诱发心室心律失常，推测是在心室兴奋性的电易损期发生的。这种导致心脏骤停的钝性胸部撞击情况增加了我们对运动场上猝死原因范围的理解，并可能有助于制定预防措施。
