New York State In-depth

What led to the collapse of Buffalo Bills’ Damar Hamlin?

A possible cause of the safety of Buffalo Bill’s Damar Hamlin’s harrowing collapse and cardiac arrest – witnessed in real time by millions of Monday Night Football viewers – was immediately recognized by heart experts who also happened to be watching the game.

“I knew exactly what was going on,” said Dr. Nahush Mokadam, department head of cardiac surgery at Ohio State University Wexner Medical Center. “The way he first got up and then collapsed… that’s not what a concussion would look like.”

In a statement released Tuesday, Hamlin’s family thanked first responders and medical staff at the University of Cincinnati Medical Center, where he is being treated.

“On behalf of our family, we would like to express our sincere gratitude for the love and support shown to Damar at this challenging time,” the family wrote.

Hamlin remained on a ventilator in critical condition at the University of Cincinnati Medical Center as of Wednesday afternoon, according to a report by TODAY. There was no official update on his recovery.

Neither Mokadam nor any other doctor interviewed for this story is involved in Hamlin’s treatment. In a statement, the Bills said only that Hamlin went into cardiac arrest when the heart stopped beating properly and is in critical condition.

Damar Hamlin at Orchard Park, NY in 2021. Joshua Bessex / AP file

It was during the first quarter of Monday night’s game between the Bills and the Cincinnati Bengals when 24-year-old Hamlin attacked a Bengals receiver, colliding with his chest. Hamlin got up after the duel, but collapsed immediately.

While there are several possible causes of Hamlin’s cardiac arrest, cardiologists suggested a rare phenomenon called “commotio cordis” was to blame.

In such cases, “there’s nothing wrong with the heart,” said Dr. Hari Tandri, director of the cardiac arrhythmia program at Vanderbilt University Medical Center in Nashville, Tennessee. A healthy heart, if hit with blunt force at any given point, can slip into an abnormal and potentially fatal rhythm, according to Tandri.

A spokesman for the American Heart Association, Dr. Comilla Sasson, an emergency medical technician in Denver, said: “It’s not about how hard the hit was. It’s actually about when the blow hits.”

Normally, the heart pumps oxygen-rich blood through the body about every second. The process has a rhythm that keeps blood flow at a healthy pace. But every time the heart beats, there’s a tiny moment — less than a fifth of a second — that makes it vulnerable to the impact of a projectile like a hockey puck or a baseball, which can result in a chaotic and potentially deadly heart rhythm.

Experts say that at that precise moment, a blow to the chest in just the right place can send an otherwise healthy person into cardiac arrest. The heart’s electrical system fails and the rhythm of the heart beat gets confused.

Seconds after such an injury are critical to patient survival, Sasson said.

“For every minute you don’t have CPR, your chances of survival drop by about 10%,” she said. In Hamlin’s case, medical personnel rushed to the sidelines to perform CPR until he was stable enough to be taken by ambulance for further treatment.

Commotio cordis is thought to occur about 15 to 20 times a year in the United States, mostly in youth who participate in sports like baseball, hockey or lacrosse, said Dr. Mark Link, a cardiologist at the University of Texas Southwestern Medical Center.

It’s even rarer in people over 20 because the ribs harden with age and are better able to protect against blunt trauma, said Link, a commotio cordis expert who is a clinical cardiac electrophysiologist who specializes in heart rhythm problems.

NFL players undergo health screenings, which may include heart scans, to detect potential health issues long before they step onto the field.

That suggests an underlying heart condition probably wouldn’t go unnoticed, Mokadam said.

But there are several other reasons a person may go into cardiac arrest. Sometimes a blood vessel in the heart muscle swells and bursts.

Mokadam said that probably didn’t happen in Hamlin’s case. “If it had been a ruptured aneurysm, he would have needed emergency open-heart surgery,” he said. “CPR and an AED will not solve the problem.” (AED refers to a form of defibrillation treatment.)

What’s next?

Doctors say the 24 hours after such an injury are critical. Doctors will most likely run a series of tests to ensure there are no underlying heart problems that could have led to Hamlin’s collapse or injuries sustained after Monday night’s crash. They might include an ultrasound of the heart, a heart MRI, and CT scans of the brain.

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