title: Development of a Chest Wall Protector Effective in Preventing Sudden Cardiac Death by Chest Wall Impact (Commotio Cordis).
abstract: OBJECTIVE
  Commotio cordis, sudden death with chest impact, occurs clinically despite chest wall protectors worn in sports. In an experimental model of commotio cordis, commercially available chest wall protectors failed to prevent ventricular fibrillation (VF). The goal of the current investigation was to develop a chest wall protector effective in the prevention of commotio cordis.
  
  
  METHODS
  In the Tufts experimental model of commotio cordis the ability of chest protectors to prevent VF was assessed. Impacts were delivered with a 40-mph lacrosse ball, timed to the vulnerable period for VF.
  
  
  METHODS
  A chest wall protector or no chest wall protector (control) was randomly assigned to be placed over the chest. Four iterative series of 2 to 4 different chest wall material combinations were assessed. Materials included 3 different foams (Accelleron [Unequal Technologies, Glen Mills, PA], closed cell high density foam; Airilon [Unequal Technologies, Glen Mills, PA], closed cell low density soft foam; and an open cell memory foam) that were adhered to a layer of TriDur (Unequal Technologies, Glen Mills, PA), a flexible elastomeric coated aramid that was bonded to a semirigid polypropylene polymer (ImpacShield, Unequal Technologies, Glen Mills, PA).
  
  
  METHODS
  Induction of VF by chest wall impact was the primary outcome.
  
  
  RESULTS
  Of 80 impacts without chest protectors, 43 (54%) resulted in VF. Ventricular fibrillation with chest protectors ranged from a high of 60% to a low of 5%. Of 12 chest protectors assessed, only 3 significantly lowered the risk of VF compared with impacts without chest protectors. These 3 chest protectors were combinations of Accelleron, Airilon, TriDur, and ImpacShield of different thicknesses. Protection increased linearly with the thicker combinations.
  
  
  CONCLUSIONS
  Effective protection against VF with chest wall protection can be achieved in an experimental model of commotio cordis.
  
  
  CONCLUSIONS
  Chest protector designs incorporating these novel materials will likely be effective in the prevention of commotio cordis on the playing field.
authors.affiliation: The Cardiac Arrhythmia Center, Tufts Medical Center, Boston, MA.
authors.forename: Kartik
authors.initials: K
authors.lastname: Kumar
authors.forename: Swati N
authors.initials: SN
authors.lastname: Mandleywala
authors.forename: Michael P
authors.initials: MP
authors.lastname: Gannon
authors.forename: Nathan Anthony Mark
authors.initials: NA
authors.lastname: Estes
authors.forename: Jonathan
authors.initials: J
authors.lastname: Weinstock
authors.forename: Mark S
authors.initials: MS
authors.lastname: Link
mesh_terms: D000818:Animals; D001265:Athletic Injuries / Q000517:prevention & control*; D016757:Death, Sudden, Cardiac / Q000209:etiology* / Q000517:prevention & control; D008297:Male; D011481:Protective Clothing; D013552:Swine; D014693:Ventricular Fibrillation / Q000209:etiology / Q000517:prevention & control