What is Cardiac Arrest?

Cardiologist M. Kate Elfrey, D.O., of The Heart Center at Mercy, responded to questions from Healthline regarding Buffalo Bills player Damar Hamlin, 24, who suffered cardiac arrest while playing in a nationally televised NFL contest against the Cincinnati Bengals in January 2023.

What happens to the heart and body during cardiac arrest?

During cardiac arrest there is an underlying trigger that causes the heart to either stop beating or to enter a dangerous heart rhythm called ventricular fibrillation. Once the heart stops or goes into ventricular fibrillation, it is no longer able to sufficiently pump blood to the organs in our body. Once the organs in our body are no longer able to get blood delivered from the heart, they will stop functioning. We worry most about the brain. When the heart is not able to get blood to the brain we lose consciousness with loss of brain function.

Why?

There are several causes for cardiac arrest, the most common are related to having an underlying structural heart problem. This could include having a weak heart muscle, having a thick heart muscle or having blockages in your arteries that decrease blood flow to your heart muscle. In rare circumstances, this can also occur with blunt trauma to the chest, specifically called commotio cordis. There are many other non-cardiac reasons as well.

Why does cardiac arrest occur in a young healthy athlete?

Cardiac arrest can occur in young healthy athletes that participate in competitive sports. Blunt trauma to the anterior chest at just the right time in the cardiac cycle can trigger ventricular fibrillation. This most commonly occurs in males between the ages of 10 and 17. At this age, the sternum and rib cage are not completely developed, and therefore the heart is more susceptible to blunt force injury. Common scenarios would be a baseball or lacrosse ball or hockey puck hitting the athlete directly in the chest.

Could the tackle have played a role?

Commotio cordis is not common in football. As previously noted, it is mostly seen with blunt trauma to the chest via a ball or puck. However, it is possible that an elbow to the chest during a tackle could have contributed enough blunt force to cause commotio cordis.

What can you do if someone goes into cardiac arrest during a sporting event?

The most important thing all of us can do is learn CPR and basic life support. Bystanders at sporting events who are trained in CPR should be willing to help and assist in treating an athlete that has lost consciousness. You never know when you'll have the chance to save a life and when that chance comes, you want to be prepared. Knowing how to check a pulse and use an Automatic External Defibrillator, or AED, will save lives!

How is cardiac arrest treated?

Cardiac arrest is treated with CPR and advanced cardiac life support. You do not have to be a physician to be trained in CPR. The goal of CPR is to restore the heart to a normal rhythm. Once this happens, we then focus on the underlying cause of why cardiac arrest occurred and on protecting the brain and body organs from lack of oxygen.

What is the recovery like?

Recovery is different for each person depending on the scenario. If the individual received CPR very quickly and their heart rhythm was restored, they are more likely to have a positive outcome. If they went for a long time without CPR, and without blood flow to the brain, then unfortunately, the chance of a full recovery is poor.

All of these people will be treated in a hospital under a high level of care with close monitoring of their heart and brain function.

Some individuals will make a full and complete recovery. Some unfortunately will not survive. Others might have their heart rhythm restored, however, they may suffer from neurologic injury, such as memory loss. Some might have long-term damage to their heart muscle.

Everyone responds differently but one thing is clear, the best chance of a full recovery is when CPR is started immediately and done effectively. Learn CPR today! Save a life!

Dr. Elfrey is a graduate of the New York College of Osteopathic Medicine and completed her residency at Johns Hopkins Bayview Medical Center. On staff at The Heart Center at Mercy, Dr. Elfrey sees patients at Mercy Personal Physicians at Overlea, Lutherville, and in downtown Baltimore. The cardiologists of The Heart Center at Mercy specialize in the diagnosis, treatment and prevention of heart disease including coronary artery disease (CAD), heart attack and high blood pressure.