title: Increasing survival rate from commotio cordis.
abstract: BACKGROUND
  Commotio cordis events due to precordial blows triggering ventricular fibrillation are a cause of sudden death (SD) during sports and also daily activities. Despite the absence of structural cardiac abnormalities, these events have been considered predominantly fatal with low survival rates.
  
  
  OBJECTIVE
  To determine whether expected mortality rates for commotio cordis have changed over time, associated with greater public visibility.
  
  
  METHODS
  US Commotio Cordis Registry was accessed to tabulate frequency of reported SD or resuscitated cardiac arrest over 4 decades.
  
  
  RESULTS
  At their commotio cordis event, 216 study patients were 0.2-51 years old (mean age 15±9 years); 95% were males. Death occurred in 156 individuals (72%), while the other 60 (28%) survived. Proportion of survivors increased steadily with concomitant decrease in fatal events. For the initial years (1970-1993), 6 of 59 cases survived (10%), while during 1994-2012, 54 of 157 (34%) survived (P = .001). The most recent 6 years, survival from commotio cordis was 31 of 53 (58%), with survivor and nonsurvivor curves ultimately crossing. Higher survival rates were associated with more prompt resuscitation (40%<3 minutes vs 5%>3 minutes; P<.001) and participation in competitive sports (39%; P<.001), but with lower rates in African Americans (1 of 24; 4%) than in whites (54 of 166; 33%; P = .004). Independent predictors of mortality were black race (P = .045) and participation in noncompetitive sports (P = .002), with an on-site automated external defibrillator use protective against SD (P = .01).
  
  
  CONCLUSIONS
  Survival from commotio cordis has increased, likely owing to more rapid response times and access to defibrillation, as well as greater public awareness of this condition.
authors.affiliation: Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota 55407, USA. bmaron@mhif.org
authors.forename: Barry J
authors.initials: BJ
authors.lastname: Maron
authors.forename: Tammy S
authors.initials: TS
authors.lastname: Haas
authors.forename: Aneesha
authors.initials: A
authors.lastname: Ahluwalia
authors.forename: Ross F
authors.initials: RF
authors.lastname: Garberich
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; D000367:Age Factors; D000704:Analysis of Variance; D016887:Cardiopulmonary Resuscitation / Q000401:mortality*; D002648:Child; D056104:Commotio Cordis / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D016757:Death, Sudden, Cardiac; D047548:Defibrillators; D004554:Electric Countershock / Q000401:mortality*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis; D055815:Young Adult