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Development of a Chest Wall Protector Effective in Preventing Sudden Cardiac Death by Chest Wall Impact (Commotio Cordis)

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...

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Autores principales: Kumar, Kartik, Mandleywala, Swati N., Gannon, Michael P., Estes, Nathan Anthony Mark, Weinstock, Jonathan, Link, Mark S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Clinical Journal of Sport Medicine 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5181132/
https://www.ncbi.nlm.nih.gov/pubmed/27014942
http://dx.doi.org/10.1097/JSM.0000000000000297
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author Kumar, Kartik
Mandleywala, Swati N.
Gannon, Michael P.
Estes, Nathan Anthony Mark
Weinstock, Jonathan
Link, Mark S.
author_facet Kumar, Kartik
Mandleywala, Swati N.
Gannon, Michael P.
Estes, Nathan Anthony Mark
Weinstock, Jonathan
Link, Mark S.
author_sort Kumar, Kartik
collection PubMed
description 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. DESIGN: 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. INTERVENTION: 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). MAIN OUTCOME MEASURE: 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. CLINICAL RELEVANCE: Chest protector designs incorporating these novel materials will likely be effective in the prevention of commotio cordis on the playing field.
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spelling pubmed-51811322017-01-06 Development of a Chest Wall Protector Effective in Preventing Sudden Cardiac Death by Chest Wall Impact (Commotio Cordis) Kumar, Kartik Mandleywala, Swati N. Gannon, Michael P. Estes, Nathan Anthony Mark Weinstock, Jonathan Link, Mark S. Clin J Sport Med Original Research 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. DESIGN: 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. INTERVENTION: 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). MAIN OUTCOME MEASURE: 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. CLINICAL RELEVANCE: Chest protector designs incorporating these novel materials will likely be effective in the prevention of commotio cordis on the playing field. Clinical Journal of Sport Medicine 2017-01 2016-12-23 /pmc/articles/PMC5181132/ /pubmed/27014942 http://dx.doi.org/10.1097/JSM.0000000000000297 Text en Copyright © 2016 The Author(s). Published by Wolters Kluwer Health, Inc. All rights reserved. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (http://CreativeCommonsAttribution-NonCommercial-NoDerivativesLicense4.0) (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.
spellingShingle Original Research
Kumar, Kartik
Mandleywala, Swati N.
Gannon, Michael P.
Estes, Nathan Anthony Mark
Weinstock, Jonathan
Link, Mark S.
Development of a Chest Wall Protector Effective in Preventing Sudden Cardiac Death by Chest Wall Impact (Commotio Cordis)
title Development of a Chest Wall Protector Effective in Preventing Sudden Cardiac Death by Chest Wall Impact (Commotio Cordis)
title_full Development of a Chest Wall Protector Effective in Preventing Sudden Cardiac Death by Chest Wall Impact (Commotio Cordis)
title_fullStr Development of a Chest Wall Protector Effective in Preventing Sudden Cardiac Death by Chest Wall Impact (Commotio Cordis)
title_full_unstemmed Development of a Chest Wall Protector Effective in Preventing Sudden Cardiac Death by Chest Wall Impact (Commotio Cordis)
title_short Development of a Chest Wall Protector Effective in Preventing Sudden Cardiac Death by Chest Wall Impact (Commotio Cordis)
title_sort development of a chest wall protector effective in preventing sudden cardiac death by chest wall impact (commotio cordis)
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5181132/
https://www.ncbi.nlm.nih.gov/pubmed/27014942
http://dx.doi.org/10.1097/JSM.0000000000000297
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