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

Kumar, Kartik MBBS; Mandleywala, Swati N. MBBS; Gannon, Michael P. MD; Estes, Nathan Anthony Mark III MD; Weinstock, Jonathan MD; Link, Mark S. MD

Clinical Journal of Sport Medicine: January 2017 - Volume 27 - Issue 1 - p 26–30
doi: 10.1097/JSM.0000000000000297
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.

The Cardiac Arrhythmia Center, Tufts Medical Center, Boston, MA.

Corresponding Author: Mark S. Link, MD, Tufts Medical Center Box # 197, 800 Washington St, Boston, MA 02111 (

This study was funded by an unrestricted research grant from Unequal Technologies Company. Unequal Technologies did not control design, analysis or publication of the data.

The authors report no conflicts of interest.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (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.

Received May 30, 2015

Accepted October 20, 2015

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.