Biomechanical Analysis of Commotio Cordis.

Principle Investigator: Cynthia Bir, Ph.D.

Institution:Wayne State University, Detroit, MI

Title: Biomechanical Analysis of Commotio Cordis

Abstract:Commotio cordis has been described as a sudden death from impacts to the chest which does not result in mechanical injury to the underlying structures. Although once not completely understood, several advances have been made to delineate the underlying pathology related to this phenomenon (Maron, Poliac et al. 1995; Link, Wang et al. 1998; Link, Wang et al. 1999; Maron, Link et al. 1999; Maron, Gohman et al. 2002). A correlation between this pathology and the clinical phenomenon of ventricular fibrillation has been well documented. In addition, two distinct parameters have been related to the occurrence of VF: the timing of the impact with the cardiac cycle and pressure change with the chambers of the heart (Link, Wang et al. 1998; Link, Wang et al. 1999). In an ongoing series using an experimental model, these parameters have been monitored and/or controlled. Using this model, testing has been conducted on various padding material, full chest proctors and other protective equipment (Winstock, Maron et al. 2006). Although these tests have provided significant results, the wide-spread, long-term use of this model to evaluate protective equipment is not feasible; therefore, it is important to identify an alternative model for ongoing testing and research.

The objective of this proposal is to conduct a biomechanical analysis of blunt impacts to the chest resulting in sudden cardiac death or commotio cordis and to produce a high fidelity mechanical model which would be utilized for the assessment of chest wall protection in sports. In order to accomplish the objective of this proposal, the following specific aims will be pursued:

Specific Aim 1: To develop or validate an appropriate injury criterion for the prediction of severe or fatal injuries, such as ventricular fibrillation, associated with projectile impacts. The need exists for the validation of an injury criterion to predict the risk of commotio cordis. Injury criteria allow for the ability to predict a risk of injury based on a measured parameter.

Specific Aim 2: To validate a biomechanical thoracic model representative of the youth population for the evaluation of sports-related projectile impacts. Currently, there is a lack of a validated surrogate to quantify the risk of injury associated with impacts to the chest in sports. Chest protectors are routinely being used without any type of efficacy testing.