The speedy on-site emergency response by trained medical staff is widely credited with helping save Damar Hamlin’s life. But whether his cardiac arrest could have been prevented is much less certain.
Doctors say they are still investigating what caused Hamlin’s heartbeat after a tackle during Monday night’s game in Cincinnati. One possibility — a type of chest trauma called commotio cordis — is impossible to predict or prevent.
Pre-existing heart disease is the leading cause of sudden cardiac arrest in young athletes. Some of them can be detected by tests, including EKGs, which measure the heart’s electrical activity, and echocardiograms, which are ultrasound imaging tests that show how the heart muscle and heart valves are working.
These tests cannot detect all heart conditions and sometimes miss those that can be fatal. They’re routine in professional sports and used by about half of NCAA programs, said Dr. Andrew Peterson, University of Iowa team doctor.
The American Heart Association and American Academy of Pediatrics do not recommend them for routine use in high school and youth sports because false-positive results would disqualify too many athletes, Peterson said.
Routine physical exams should include questions about a family history of heart disease and worrisome symptoms like fainting, rapid heart rate, and chest pain during activity, said Dr. Mariell Jessup, Chief Medical Officer of the Heart Association. Heart tests would be warranted to investigate these symptoms, she said.
“It’s possible for someone to reach adulthood without being diagnosed,” she noted. “This happens especially in population groups that are underserved or do not have the opportunity to see a doctor regularly.”
Hamlin’s health history has not been released. Buffalo Bills, 24, remains hospitalized but doctors say he’s making remarkable progress, speaking and breathing on his own.
Jessup said Hamlin “was extraordinarily fortunate that there were people who knew about CPR” and that it started immediately.
He also benefited from the NFL’s routine emergency drills held at stadiums before each game.
“The meeting is an essential checkpoint to ensure officials, team medical personnel, and game-day medical personnel are aware of all in-game health and safety procedures and resources,” states NFL’s online health and safety information players.
Sudden cardiac arrest is one of the things they try to prepare for. It is the leading medical cause of death in young athletes, although it is rare, with an estimated 1 sudden cardiac death in 50,000 to 80,000 young athletes per year.
A rare cause of these deaths is the commotio cordis, which occurs when someone receives a sharp blow to the chest at a specific location during a specific time of the heart’s rhythm cycle. The trauma causes the heart to tremble and stop pumping blood efficiently. It used to be almost always fatal, but awareness has improved the survival rate to about 60%, said Dr. Mark Link of UT Southwestern Medical Center in Texas.
One of the most common heart conditions associated with cardiac arrest in athletes can often be detected on echocardiograms. Hypertrophic cardiomyopathy is a genetic condition that can cause part of the heart muscle to thicken, making it harder for the heart to pump blood. Affected people do not always have symptoms and often go undiagnosed.
Former Baylor basketball player King McClure had no idea he was affected until he had an EKG and echocardiogram early in his freshman year in 2015.
The diagnosis was devastating: the doctors said he could die if he kept playing. One doctor offered an option – an implanted defibrillator, which shocks the heart to restore a normal heartbeat.
The implanted device “by the grace of God was never activated,” said McClure, now 26 and an ESPN analyst.
McClure said he saw Hamlin’s breakdown and thought, “That could have been me. When you see things like this that are so close to your home, it kind of scares you,” he said. “I’m just grateful that Hamlin is okay and that he’s still here.”
Julie West of La Porte, Indiana, became an advocate for routine heart testing in schools, wider use of automated external defibrillators, and routine cardiac drills after her 17-year-old son, Jake, died of sudden cardiac arrest during soccer practice in 2013.
“For Jake, no one knew what to do right away,” she said. “The AED was in the coach’s office. The trainers stepped in and did CPR,” but it was too late.
Since then, awareness of AEDs has increased, and AED procedures are emphasized at almost every level of sport, even in high schools.
“It’s part of our CPR renewal course,” said Eric McCauliffe, Indian Lake-Long Lake, New York, girls’ college basketball coach. “We’re definitely going through it and also asking trainers about the locations of AEDs at each school.”
An autopsy revealed Jake had a rare inherited heart condition that caused no symptoms and was not detected on routine physical exams. His sister later had tests that revealed she has the same condition and now has an implanted defibrillator.
West was a teacher when Jake died and says she was trained in active marksmanship and fire, but not cardiac arrest.
“If they don’t have a cardiac response plan, they are unprepared,” she said.
She started a foundation that organizes EKG and echocardiogram screenings in Indiana schools.
West knows the tests aren’t perfect, but for her, saving a life is worth it.
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AP sportswriters Tim Reynolds, Ron Blum and Ralph Russo contributed.
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Follow AP Medical Writer Lindsey Tanner at @LindseyTanner.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.
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