Korean J Crit Care Med.  2015 Nov;30(4):349-353. 10.4266/kjccm.2015.30.4.349.

Recurrent Pulseless Ventricular Tachycardia Induced by Commotio Cordis Treated with Therapeutic Hypothermia

Affiliations
  • 1Department of Emergency Medicine, Hanyang University College of Medicine, Hanyang University Hospital, Seoul, Korea. emer0905@gmail.com
  • 2Department of Emergency Medicine, Hanyang University Guri Hospital, Guri, Korea.

Abstract

The survival rate of commotio cordis is low, and there is often associated neurological disability if return of spontaneous circulation (ROSC) can be achieved. We report a case of commotio cordis treated with therapeutic hypothermia (TH) that demonstrated a favorable outcome. A 16-year-old female was transferred to our emergency department (ED) for collapse after being struck in the chest with a dodgeball. She has no history of heart problems. She was brought to our ED with pulseless ventricular tachycardia (VT), and ROSC was achieved with defibrillation. She was comatose at our ED and was treated with TH at a target temperature of 33degrees C for 24 hours. After transfer to the intensive care unit, pulseless VT occurred, and defibrillation was performed twice. She recovered to baseline neurologic status with the exception of some memory difficulties.

Keyword

commotio cordis; tachycardia; therapeutic hypothermia; ventricular; thoracic injury

MeSH Terms

Adolescent
Coma
Commotio Cordis*
Emergency Service, Hospital
Female
Heart
Humans
Hypothermia*
Intensive Care Units
Memory
Survival Rate
Tachycardia
Tachycardia, Ventricular*
Thoracic Injuries
Thorax

Figure

  • Fig. 1. Serial findings of electrocardiography. (A) An electrocardiograph at another emergency department showed sinus tachycardia (heart rate = 107 beats/minutes) (B) Pulseless ventricular tachycardia was shown, for which a shock of 200J was immediately administered.

  • Fig. 2. Chest radiography findings. Chest radiograph on hospitalized day 1 showing diffuse opacity on both lung fields. This finding was consistent with bilateral pulmonary edema.

  • Fig. 3. The findings of brain computed tomography. Brain computed tomography on hospitalized day 2 showed an attenuation of lobar gray-white matter differentiation.


Reference

References

1. Maron BJ, Gohman TE, Kyle SB, Estes NA 3rd, Link MS. Clinical profile and spectrum of commotion cordis. JAMA. 2002; 287:1142–6.
2. Maron BJ, Ahluwalia A, Haas TS, Semsarian C, Link MS, Estes NA 3rd. Global epidemiology and demographics of commotion cordis. Heart Rhythm. 2011; 8:1967–71.
3. Maron BJ, Doerer JJ, Hass TS, Estes NA, Hodges JS, Link MS. Commotio cordis and the epidemiology of sudden death in competitive lacrosse. Pediatrics. 2009; 124:996–71.
Article
4. Maron BJ, Poliac LC, Kaplan JA, Mueller FO. Blunt impact to the chest leading to sudden death from cardiac arrest during sports activities. N Engl J Med. 1995; 333:337–42.
Article
5. Link MS, Wang PJ, Pandian NG, Bharati S, Udelson JE, Lee MY, et al. An experimental model of sudden death due to low-energy chest-wall impact (commotion cordis). N Engl J Med. 1998; 338:1805–11.
6. Peberdy MA, Callaway CW, Neumar RW, Geocadin RG, Zimmerman JL, Donnino M, et al. Part 9: postcardiac arrest care: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2010; 122(18 Suppl 3):S768–86.
7. Park HS, Han SW, Cho YK, Yun HJ, Lee YS, Hyun DW, et al. A case of commotio cordis. Korean Circ J. 2003; 33:719–22.
Article
8. Jo UR, Park SM, Lee KJ, Lee YH, Ahn JY, Sohn YD, et al. Comotio cordis by a traffic accident visited the emergency department. J Korean Soc Emerg Med. 2014; 25:484–8.
9. Link MS, Maron BJ, VanderBrink BA, Takeuchi M, Pandian NG, Wang PJ, et al. Impact directly over the cardiac silhouette is necessary to produce ventricular fibrillation in an experimental model of commotio cordis. J Am Coll Cardiol. 2001; 37:649–54.
Article
10. Link MS, Maron BJ, Wang PJ, VanderBrink BA, Zhu W, Estes Nar 3rd. Upper and lower limits of vulnerability to sudden arrhythmic death with chest-wall impact (commotio cordis). J Am Coll Cardiol. 2003; 41:99–104.
Article
11. Kaplan JA, Karofsky PS, Volturo GA. Commotio cordis in two amateur ice hockey players despite the use of commercial chest protectors: case reports. J Trauma. 1993; 34:151–3.
12. Abrunzo TJ. Commotio cordis. The single, most common cause of traumatic death in youth baseball. Am J Dis Child. 1991; 145:1279–82.
13. Dickman GL, Hassen A, Luckstead EF. Venticular fibrillation following baseball injury. Phys Sport Med. 1978; 6:85–6.
14. Green ED, Simson LR Jr, Kellerman HH, Horowitz RN, Sturner WQ. Cardiac concussion following softball blow to the chest. Ann Emerg Med. 1980; 9:155–7.
Article
15. Ota K, Bratincsak A. Atrial fibrillation induced by commotio cordis secondary to a blunt chest trauma in a teenage boy. Pediatrics. 2015; 135:e199–210.
Article
16. Maron BJ, Estes NA 3rd. Commotio cordis. N Engl J Med. 2010; 362:917–27.
Article
17. Link MS. Commotio cordis: ventricular fibrillation triggered by chest impact-induced abnormalities in repolarization. Circ Arrhythm Electrophysiol. 2012; 5:425–32.
18. Hammer MD, Krieger DW. Hypothermia for acute ischemic stroke: not just another neuroprotectant. Neurologist. 2003; 9:280–9.
Article
19. Olsen TS, Weber UJ, Kammersgaard LP. Therapeutic hypothermia for acute stroke. Lancet Neurol. 2003; 2:410–6.
Article
20. Auer RN. Non-pharmacologic (physiologic) neuroprotection in the treatment of brain ischemia. Ann N Y Acad Sci. 2001; 939:271–82.
Article
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