Forensic Pathological Identification and Antidiastole of Commotio Cordis.

Commotio cordis （CC） is the acute death caused by the cardiac rhythm disorder after a sudden blunt external force to the precordium of a healthy person without previous heart disease. As one type of violent heart damage, CC is rare with relatively small external force and sudden death, therefore causing disputes. This paper reviews the epidemiology, mechanisms and the key points in forensic identification of CC, discusses the identification and antidiastole of CC, myocardial contusion, sudden cardiac death and death from inhibition, and provides assistance to forensic pathologists to identify such causes of death.

Commotio cordis in non-sports-related injury: A scoping review.

Commotio cordis is a rare but life-threatening condition characterized by sudden cardiac arrest resulting from a blunt chest impact. While commotio cordis has traditionally been associated with sports-related activities, a significant proportion of cases occur in non-sport-related settings, such as assaults, motor vehicle accidents (MVAs), and daily activities. This critical review examines the epidemiology, clinical characteristics, and outcomes of non-sports-related commotio cordis cases, highlighting the need for increased awareness and improved management in these contexts. The review analyzes existing literature, drawing attention to the demographics of non-sports-related cases, which predominantly affect adolescents and young adults, with males being the primary demographic. In contrast to sport-related cases, non-sports-related commotio cordis cases exhibit a wider age range and a higher proportion of female subjects. Mortality rates are significantly higher in non-sports-related commotio cordis cases, largely due to lower rates of cardiopulmonary resuscitation (CPR), limited access to automated external defibrillators (AEDs), and delayed initiation of resuscitative efforts compared to sport-related incidents. This underscores the critical importance of increasing awareness and preparedness in non-sport-related settings. To mitigate the risks associated with non-sports-related commotio cordis, efforts should focus on early recognition of the condition, timely administration of CPR, and the widespread availability and accessibility of AEDs in various environments. Enhanced awareness and education can potentially lead to a reduction in mortality and improved outcomes for individuals affected by commotio cordis outside of sports-related activities. In conclusion, commotio cordis is not exclusive to sports and presents a significant health risk in non-sport-related scenarios. This review emphasizes the urgent need for increased awareness, preparedness, and resuscitation measures in non-sports contexts to address the higher mortality associated with these cases.

Commotio Cordis in Non-Sport-Related Events: A Systematic Review.

BACKGROUND: Commotio cordis is an increasingly recognized cause of sudden cardiac death. Although commonly linked with athletes, many events occur in non-sport-related settings. OBJECTIVES: The goal of this study was to characterize and compare non-sport-related vs sport-related commotio cordis. METHODS: PubMed and Embase were searched for all cases of commotio cordis from inception to January 5, 2022. RESULTS: Of 334 commotio cordis cases identified, 121 (36%) occurred in non-sport-related contexts, which included assault (76%), motor vehicle accidents (7%), and daily activities (16%). Projectiles were implicated significantly less in non-sport-related events (5% vs 94%, respectively; P < 0.001). Nonprojectile etiologies in non-sport-related events mostly consisted of impacts with body parts (79%). Both categories affected similar younger aged demographic (P = 0.10). The proportion of female victims was significantly higher in non-sport-related events (13% vs 2%, respectively; P = 0.025). Mortality was significantly higher in non-sport-related events (88% vs 66%, respectively; P < 0.001). In non-sport-related events, rates of cardiopulmonary resuscitation (27% vs 97%, respectively; P < 0.001) and defibrillation (17% vs 81%, respectively; P < 0.001) were both lower and resuscitation was more commonly delayed beyond 3 min (80% vs 5%, respectively; P < 0.001). CONCLUSIONS: Commotio cordis occurs across a spectrum of non-sport-related settings including assault, motor vehicle accidents, and daily activities. Both categories affected a younger and male-predominant demographic. Mortality is higher in non-sport-related commotio cordis, likely owing to lower rates of cardiopulmonary resuscitation, defibrillation, automated external defibrillator availability, and extended time to resuscitation. Increased awareness of non-sport-related commotio cordis is essential to develop a means of prevention and mortality reduction, with earlier recognition and prompt resuscitation measures.

Commotio Cordis Caused by Violence in China: Epidemiological Characteristics Detected at the Tongji Forensic Medical Center.

Commotio cordis (CC) is a recognized rare cause of sudden death in which an apparently minor blow to the chest causes ventricular fibrillation and cardiac arrest. CC diagnosis is still a challenge for forensic pathologists. A retrospective study of 9794 autopsy cases was conducted at the Department of Forensic Medicine, Tongji Medical College (DFM-TMC, China) from 1955 to 2014. A total of 39 cases (0.4%) were determined to be caused by CC. A male preponderance (male to female of 37:2) was found in the victims, whose age ranged from 13 to 47 years, including more than 85% individuals in their 10s and 20s. Most victims (27 cases, 69.2%) came from village. The highest rate of victims was found for middle school and college students (15 cases, 38.5%), followed by prisoners (11 cases, 28.2%), farmers (9 cases, 23.1%), workers (3 cases, 7.7%), and office staff (1 case, 2.6%). Chest blows were produced by fists (28 cases, 71.8%), feet (6 cases, 15.4%), knee (2 case, 5.1%), head (1 case, 2.6%), or objects (2 cases, 5.1%). Witness statements indicated that most victims collapsed after being impacted in the precordium. The autopsy findings were unremarkable except bruises, contusions, or subcutaneous hemorrhage in the anterior chest (13 cases), bleeding of intercostal muscles (5 cases), and disperse focal petechiae of the epicardium (11 cases). All CC cases in this study were caused by violent attacks and related to criminal processes. Correct diagnosis of CC due to violence has important implications in the judicial system.

Forensic Pathological Identification and Antidiastole of Commotio Cordis / 法医学杂志

Commotio cordis （CC） is the acute death caused by the cardiac rhythm disorder after a sudden blunt external force to the precordium of a healthy person without previous heart disease. As one type of violent heart damage, CC is rare with relatively small external force and sudden death, therefore causing disputes. This paper reviews the epidemiology, mechanisms and the key points in forensic identification of CC, discusses the identification and antidiastole of CC, myocardial contusion, sudden cardiac death and death from inhibition, and provides assistance to forensic pathologists to identify such causes of death.

Global epidemiology and demographics of commotio cordis.

BACKGROUND: The commotio cordis literature has largely focused on events occurring in the United States. However, with enhanced public awareness, commotio cordis has been increasingly recognized internationally as a cause of cardiac arrest and sudden death due to blunt nonpenetrating chest blows. OBJECTIVE: This study sought to characterize the demographics of commotio cordis globally in comparison to the U.S. experience. METHODS: This study used interrogation of the Commotio Cordis Registry (Minneapolis, Minnesota). RESULTS: We report 60 cases of commotio cordis occurring outside the United States from 19 countries (most commonly the United Kingdom and Canada) on 5 continents and compared these events to 2:3 occuring in the U.S. In the 2 groups, events were largely similar demographically, including frequency of survival (26% in U.S. vs 25%; P = .84), and the striking male predominance evident in both groups (i.e., 95%), although non-U.S. victims were somewhat older (19 ± 13 vs 15 ± 9; P = .002). Not unexpectedly, the groups differed with baseball/softball and football predominant in the United States (55% of events) and soccer, cricket, and hockey most common internationally (47% of events). Notably, the frequency with which soccer participation caused commotio cordis was much more common than expected, particularly in non-U.S. athletes (20% vs 3% U.S.; P < .001). CONCLUSION: Commotio cordis demonstrates a global occurrence, very similar demographically in the United States and internationally. However, the frequency with which chest blows from soccer balls caused commotio cordis events (particularly during sports played internationally) seems to contradict the prevailing notion that air-filled projectiles convey less risk for ventricular fibrillation than do those with solid cores (e.g., baseball or lacrosse balls).

Sobre las características de los supervivientes de muerte súbita cardiaca extrahospitalaria / On the characteristics of out-of-hospital sudden cardiac death survivors

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Muerte neurocardíaca. Revisión y claves de futuro / Neurocardiac death. Review and key trends

Las investigaciones demuestran que determinadas lesiones neurológicas centrales pueden comprometer el control autonómico cardíaco, siendo la causa fundamental de una cascada de eventos que concluye en una arritmia fatal y a una muerte súbita e inesperada. La hipótesis neurocardíaca puede postularse como una explicación común para diversas formas de muerte súbita en las que el estudio post mortem no evidencia la causa última de muerte. El córtex insular se postula como una región crucial para el control de las funciones autonómicas, especialmente para la regulación cardíaca. En este sentido, una mayor comprensión de las consecuencias del daño neurológico contribuiría a entender los mecanismos subyacentes a la muerte neurocardíaca, repercutiendo en la implementación de estrategias diagnósticas y preventivas (AU)

Research shows that certain central neurological lesions may compromise cardiac autonomic control, being the root cause of a cascade of events that ends in fatal arrhythmia and sudden unexpected death. Neurocardiac hypothesis can be postulated as a common explanation for various forms of sudden death in which no postmortem evidence ultimate cause of death. Insular cortex is postulated as a critical region for control of autonomic functions, especially for cardiac regulation. Further understanding of the consequences of neurological damage contribute to understand the mechanisms underlying neurocardiac death, affecting the implementation of diagnostic and preventive strategies (AU)