title: Failure of commercially available chest wall protectors to prevent sudden cardiac death induced by chest wall blows in an experimental model of commotio cordis.
abstract: OBJECTIVE
  Sudden cardiac death that results from chest wall blows (commotio cordis) the second leading cause of death in young athletes. Most events are caused by blows from projectiles, such as baseballs or lacrosse balls, with a substantial proportion occurring despite the use of a chest protector. In the present experiment, we tested the effectiveness of commercially available chest protectors in preventing ventricular fibrillation (VF) that results from chest wall strikes with baseballs and lacrosse balls.
  
  
  METHODS
  Twelve different baseball or lacrosse chest protectors were evaluated in juvenile swines that were subjected to 40-mph baseball or lacrosse ball blows to the precordium during the vulnerable period of repolarization for VF and were compared with control impacts without chest protectors. Seven baseball chest protectors were hit by regulation baseballs, and 5 lacrosse chest protectors were tested by blows with standard lacrosse balls. Each animal received 2 chest blows for each protector and 2 control impacts without a chest protector, with the sequence of impacts assigned randomly.
  
  
  RESULTS
  VF was elicited by 12 (32%) of 37 strikes in control animals without baseball chest protectors. None of the baseball chest wall protectors tested were shown to decrease significantly the occurrence of VF when compared with controls. VF was elicited by 11 (46%) of 24 strikes in control animals without lacrosse chest protectors. None of the lacrosse chest wall protectors tested decreased significantly the occurrence of VF when compared with controls.
  
  
  CONCLUSIONS
  In our experimental animal model of commotio cordis, commercially available baseball and lacrosse chest wall protectors were ineffective in protecting against VF that was triggered by chest blows and, by inference, sudden cardiac death. Improvements in materials and design of chest wall barriers are necessary to reduce the occurrence of these tragic events and make the athletic field safer for youths.
authors.affiliation: Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Tufts University School of Medicine, Tufts-New England Medical Center, Boston, Massachusetts, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Weinstock
authors.forename: Barry J
authors.initials: BJ
authors.lastname: Maron
authors.forename: Christopher
authors.initials: C
authors.lastname: Song
authors.forename: Paresh P
authors.initials: PP
authors.lastname: Mane
authors.forename: N A Mark
authors.initials: NA
authors.lastname: Estes
authors.forename: Mark S
authors.initials: MS
authors.lastname: Link
mesh_terms: D000293:Adolescent; D000818:Animals; D001484:Baseball / Q000293:injuries; D002648:Child; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D011482:Protective Devices; D015865:Racquet Sports / Q000293:injuries; D019876:Sports Equipment; D013552:Swine; D013898:Thoracic Injuries / Q000150:complications* / Q000517:prevention & control; D035441:Thoracic Wall / Q000293:injuries; D014693:Ventricular Fibrillation / Q000209:etiology / Q000517:prevention & control; D014949:Wounds, Nonpenetrating / Q000150:complications