Electricity fuels the heart like a machine, beating in synchronicity. In the face of blunt trauma, the electrical system goes haywire, causing the heart to stop. 

“That thump actually creates an electrical force, and if it hits in just the right part of the cycle, it can actually cause the heart to leave the normal rhythm and go into a chaotic rhythm that does not sustain a pulse,” said Dr. John P Erwin, a cardiologist with Northshore University Health System.  

Erwin, like many others, was watching the Monday Night Football game when the unthinkable happened: Buffalo defensive back Damar Hamlin suffered a cardiac arrest on the field following a tackle.

“When you see someone fall like that, you think cardiac event,” Erwin said.  

About 200 cases of commotio cordis have been recorded in medical literature since 1995. Classically, people appear fine, as Hamlin did when he stood up. Then the reality. 

Dr. Jeremy Alland with Midwest Orthopaedics at Rush is also a team physician for the Chicago Bulls.  

“What’s happening is that the heart is starting to profuse the brain to get enough blood to the brain for a short period of time and then it’s not contracting enough to get enough blood up there, so then you lose consciousness,” Alland said.  

“Those rhythms are so fast that it doesn’t allow the heart to fill and pump, and it’s very chaotic; quivers rather than squeezes and you lose your pulse and that is why CPR is needed,” Erwin added.  

In that instant — time is critical. CPR can get the heart to beat normally again. 

“All the major organs are not getting the blood supply they should get until effective CPR is started,” Erwin said.  

The ideal response is with an automated external defibrillator (AED) which shocks the heart back into rhythm. The important tool is on the sidelines at professional sporting events. Alland says trained medical experts are on hand as well. 

“Maybe the best place to have this happen is at a professional sporting event because you were going to have lots of doctors, there are EMTs, you saw the ambulance out, there are trainers, there are athletic trainers, and so in reality before every season with the Bulls or with every organization we go through, it’s called an emergency action plan (EAP). So, we actually simulate these things before the season starts. 

 Medical professionals know quick action may make a difference in survival. 

 “Do the hope is that because he had early compressions and had such a great care in terms of getting everything done really, really fast and got a heartbeat back that he can survive,” Alland said.  

“If this is commotio cordis, then most of the pro athletes who have had this happen do come back and practice. I believe it was Chris Pronger, the hockey player. I think he had 12 or 15 years after his commotio cordis event that he played, and I think he’s a Hall of Famer now.”

Undiagnosed heart conditions can also cause sudden cardiac arrest, as can myocarditis following a virus, Covid, or even the common cold. Hamlin is on a ventilator which is protecting his airway and ensuring adequate oxygen levels for him right now.  

The next 48 hours will be critical to determine brain function and prognosis.