The on-field collapse and cardiac arrest of NFL safety Damar Hamlin after a tackle shocked “Monday Night Football” television viewers nationwide. Distraught players wept on the field, and the game was postponed as an ambulance carried the player from Cincinnati’s Paycor Stadium.
In an early morning statement on Tuesday, the Buffalo Bills organization reported that Hamlin’s “heartbeat was restored on the field” and that the football player is under sedation at the University of Cincinnati Medical Center. A community fundraiser that Hamlin sponsored raised $3.5 million in donations overnight.
Hamlin joins the more than 356,000 cardiac arrest cases that happen annually in the U.S. outside hospitals, according to the American Heart Association (AHA), and survival in those cases depends on fast action, according to experts. Grid spoke to the AHA’s Comilla Sasson, an emergency physician in Denver, about rescue and recovery from cardiac arrest in cases like Hamlin’s.
This interview has been edited for length and clarity.
Grid: What does it mean for an athlete, or anyone, to have a cardiac arrest, and how is that different from a heart attack?
Comilla Sasson: This is really important because even on social media last night, we saw a lot of folks say, “Oh, he had a heart attack,” and I think it is important to know the difference. A heart attack is when you have, oftentimes, a blood vessel to the heart that gets blocked, and then you have a low blood-flow state to the heart, and that causes a “heart attack” and part of your muscle to die in the heart.
That’s versus a cardiac arrest, which is where your heart stops beating completely or it goes into like a fatal arrhythmia, which is not giving blood flow to the rest of the vital organs like the brain.
And so what we saw last night, where I’m not part of his medical team treating him, but a lot of us were watching, is we do know one common cause of cardiac arrest is if someone has a direct blow to the heart, for example, you can have something called commotio cordis. Your heart basically goes into a fatal arrhythmia, that is a ventricular fibrillation or ventricular tachycardia, irregular heartbeat rhythms where the heart cannot get blood flow to the rest of the body.
G: What does that mean, an arrhythmia, to the layperson? Is it a matter of the heart beating too fast, or too slow, or just wrong?
CS: It means your normal heartbeat is not happening correctly, so that can either be too fast, or it can be too slow. But ultimately what is happening is that it’s not allowing the heart to push forward the needed blood to the brain. And so, often when we think about what can cause a cardiac arrest, especially in athletes, one of the major causes is an arrhythmia where their heart goes into a rhythm that does not allow for blood flow to get to the brain.
If you’ve ever seen a fibrillating heart, it basically is quivering. That’s what it looks like. And so, it is not able to pump the blood effectively, like we need it to. When that happens, the two most important actions are going to be starting CPR right away and then getting an automated external defibrillator to the person right away.
G: Which is what we saw last night?
CS: If you were watching last night, they started CPR right away. First of all, they recognized his heart had stopped immediately, which is probably the most important thing. And, you know, calling 911, getting medical personnel there and then starting CPR right away, which is cardiopulmonary resuscitation. That’s where we do compressions, or pushes on the heart, and then we also give breaths as well. The idea there is that you want to try to have the compressions move the blood flow to the brain and other vital organs because the heart is not able to pump. And that’s what you’re doing is you’re almost acting like an external heart in some ways. And we do provide breaths because after a certain amount of time, we need to make sure that there’s enough oxygen in the lungs to get into the brain and all the other vital organs as well.
And as we were watching things unfold last night, they did say he had nine to 10 minutes of CPR and an AED [automated external defibrillator] was brought over as well. While we don’t know exactly what happened, we can presume that, you know, they did CPR and put the [AED] pads on the chest. They had to bare his chest and put the pads on him to see if he had a shockable rhythm. That’s the ventricular fibrillation of ventricular tachycardia I mentioned. If so, then often with CPR and an AED you can have a return of a pulse.
There’s a lot of folks last night who asked, “Why didn’t they just scoop him up and run and take him right to the hospital?” Well, as an ER doctor, you know, the vast majority of patients that I take care of were treated on the scene. Most people, I should say, don’t make it to the emergency department. So, most people with a cardiac arrest, we do not transport unless they have a pulse. And so what they were doing was staying on scene, doing really good chest compressions, really good CPR, getting an AED doing all of the most important basic things. And then once they had that return of a pulse, that’s when they transported him to the hospital.
G: So, commotio cordis is suspected in this case, is this a special kind of cardiac arrest?
CS: It is a cause of cardiac arrest. There’s a lot of different causes: There can be an irregular heart rhythm; respiratory arrest, which oftentimes happens in children, where they stop breathing and then their heart stops; you can have drug overdose; you can have trauma, drowning; those are all things that can cause the cardiac arrest.
In athletes, some of the things that we also consider is something called hypertrophic cardiomyopathy. That’s a heart condition that can happen especially in professional and even elite athletes were their heart muscle actually gets so thick that it can cause the heart to have an irregular heart rhythm and potentially cause a cardiac arrest. But commotio cordis is little bit different because that’s where you have the direct blow to the chest wall. And it doesn’t have to be a super hard blow. It just has to happen at the exact wrong time and what that does is it sets the heart into that kind of fibrillation, that quivering state, because of the impact and the timing of the impact.
G: And an AED is always appropriate for cardiac arrest like we saw last night?
CS: It is always 100 percent appropriate. The big thing that I think people need to know is that first of all, if you’ve never used one, it’s OK. Because the machine literally tells you exactly what to do. You take it off the wall, you apply the pads to the chest, the machine will only shock the person if it’s the appropriate rhythm for it to shock. You don’t have to worry about “What if it shocks them inappropriately or I do something wrong?” The machine is actually built so that it will analyze the rhythm and then just determine whether or not a shock is advised.
G: The team reported late last night that Mr. Hamlin had been intubated and was in critical condition. What does that mean in this context?
CS: Yeah, you know, oftentimes when somebody’s heart stops, it’s not uncommon for us to also put a tube down their throat to help them breathe. And that’s because they’re completely unconscious and so they can’t breathe on their own. And then once we do get a pulse back, even if they have stable vital signs, meaning that their heart rate has stabilized, their blood pressure is stabilized, their body has been through a major traumatic event. So we often will leave people with the tube in their throats, intubated and on the ventilator because we’re allowing the body to heal.
Breathing is actually a lot of physical work, strain on the body, and so we’ll keep people intubated so that we can, No. 1, figure out what happened. And then, No. 2, kind of help their body with one of the most difficult things to do, which is breathing on your own. And so the fact that he’s still sedated and on the ventilator is very, very common.
And what they’re trying to ensure is that he gets appropriate blood flow to the brain, that he doesn’t have any type of injury from that. And to make sure that his other vital organs, like his kidneys and his liver, are working appropriately. So, it’s going to be a long road to recovery, but a lot of what they’re going to be doing in the next few days is trying to figure out what impact that his heart stopping had on the rest of his body.
G: Is this the kind of thing that athletes ever return to play from? Or is it more doubtful in a contact sport after this?
CS: It’s hard to just say honestly until you knew what the cause was. So if it was, let’s say, a freak accident which again, we know happens, sort of the wrong time in the wrong place kind of thing, that would be maybe more likely potentially to go back.
If it was something like hypertrophic cardiomyopathy, which is a change in this structure of the heart itself, that would be the end of many athletes’ careers.
G: Were you watching the game last night?
CS: Yes, I was watching the game on “Monday Night Football.”
G: What was your reaction?
CS: You know, I think the hardest thing to watch honestly was, I knew what’s going on because obviously, having run many cardiac arrests resuscitations myself as an ER doc, you kind of go into “OK, are they doing this, doing this, are they doing this?” — a checklist. But I think the hardest part for me, personally, was watching the players and seeing them crying.
I think a lot of folks don’t realize the mental and psychological impact, as well, of what we just watched. The trauma that can happen both for people who were there on the field, even with those folks who were watching on TV.
And then, [I was] thinking about kind of the long road to recovery that can happen for people who’ve had a cardiac arrest and they themselves oftentimes will have post-traumatic stress disorder because they’ve literally just died and had to be resuscitated, you know?
So I think for me, that was kind of the big thing that I was thinking was, you know, don’t restart the game. There’s no way, first of all.
I think that was to me, that was the hardest part. Having been through so many of those myself. It’s just so emotionally hard on the folks that are there. So I do hope that all of the players and the coaches and everybody also have the ability to talk to, you know, to somebody today like a concerned therapist because I think there’s a lot to process.
Just as a reminder, I think it’s really important for parents — and my kiddos play softball, and then baseball, where this is something that we see where kids get hit in the chest, you know, with a little baseball, even a basketball. And so I just want folks to know, especially parents, you should know how to do CPR, No. 1, and then also make sure that the coaches for your kids know what to do if there was some sort of an emergency as well.
My husband and I had a whole conversation about this last night because I don’t know if the facility where my kids play currently has access to an AED, but you better believe today I’m going to go and ask him and also going to make sure they all know how to do CPR.
Thanks to Lillian Barkley for copy editing this article.