Guarding the Heart

     During a Little League game last May, one Shoreham family nearly lost a child after a baseball struck him in the chest.

     Jack Crowley, 16, said he was pitching to his younger brother at the North Shore Little League Field batting cage in Rocky Point when he reached around the protective L-screen to pick up a ball. A line drive slammed into a spot just below his ribcage.

     “For the first couple of seconds, it just felt like getting hit with a baseball – I’ve been hit before,” said Jack, who was 15 at the time. “All of a sudden, I got really dizzy and couldn't inhale at all. Then I went to my knees and blacked out.”

     Jack estimates that he was unconscious for about two and a half minutes. He awoke with an automated external defibrillator, or AED, attached to his chest.

     “There are really no words to describe what it feels like to find your child not breathing, and blue,” Jack’s mother, Nancy, said. “They say if it was over three minutes he probably wouldn’t have survived, even with the AED.”

     Jack suffered from a rare event known as commotio cordis, a disruption of heart rhythm that results from a blow to the chest. This can lead to ventricular fibrillation – rapid, irregular contraction of the heart muscle – and sudden death.

      After this happened to Jack, Crowley said, she felt she needed to do something for all three of her boys. All play baseball.

     “I did go get them new chest protectors, although I know they’re not code of any sorts,” she said. “Whether they do any good or not, it's just something I have to do.”

      To determine whether a chest protector can decrease the risk of commotio cordis, researchers are figuring out what triggers this condition. In February 2016, The National Operating Committee on Standards for Athletic Equipment announced a new performance standard in testing whether a chest protector can withstand the trauma that would induce commotio cordis.

     This is the first standard for this type of equipment the world has seen.

     “For us to develop this standard, we have to know exactly what it is we're trying to protect against,” Mike Oliver, executive director of the standards committee, said. “We know we’re finding a phenomena. We know we’re studying to identify what it is. And we know there isn’t a standard at all for chest protectors in general.” 

     "It doesn’t work to just put more padding in because we wouldn't know if that would work or not,” Oliver said.

     He said previous data collected showed almost all of these commotio cordis incidents were in kids under the age of 14, and almost all of them boys. He said through much research and testing on live pigs, scientists pinpointed what was causing these incidents.

     “The pig heart system is very similar to what the human heart is,” Oliver said. This is because the pig chest, heart outline and response to stimuli are all nearly identical to a human’s.

    After much testing, the results showed that the blow has to land over the outline of the heart, with the velocity of a ball ranging anywhere from 30 mph to 40 mph. Oliver said the impact must happen at a precise point in the cardiac cycle known as the depolarization cycle. This very small window, lasting only about eight milliseconds, is when the heart is most vulnerable.    

     Karen Acompora, president of the Louis J. Acompora Memorial Foundation, began funding research into chest protector standards after her son died from commotio cordis during his first high school lacrosse game in 2000. He was a freshman at Northport High School on Long Island.

     In addition to supporting research on chest protection, the Acompora foundation has been doing its part in combating sudden cardiac arrest in both athletes and non-athletes. In 2002, it successfully achieved  “Louis’ Law,” which requires all New York State public schools to have AEDs in buildings and at sporting events.

     “When we had found out what had happened to Louis and had there been an AED on the field that his life would have been saved, we decided right away that we were going to figure out a way of educating schools about AEDs and the need for better chest protection,” she said.

     According to the American Heart Association, nearly 356,500 people experienced an out-of-hospital cardiac arrest in 2014.

    “Schools are mini-communities,” Acompora said. “We should have AEDs. Children die on the athletic field, and adults die in school.”

     Another front in the foundation’s campaign is its nearly 14-year battle for mandatory CPR instruction for public high school students.

     On Oct. 7, 2015, a state mandate took effect that requires all high school students to be trained in hands-only cardiopulmonary resuscitation and the use of an AED. Hands-only CPR is without mouth-to-mouth, allowing an individual to just do continuous hard compressions on the center of chest until emergency medical services arrive.

     “Schools don’t like to be told what to do, especially when it comes to curriculum, and this was an unfunded mandate,” Acompora said. “We know that bystander CPR saves lives. That's why we want more and more people to learn.”

     Public schools are required to provide hands-only CPR training to all senior high school students. According to the state mandate, hands-only CPR instructors may be uncertified, which gives schools more flexibility in choosing instructors. The American Heart Association states that hands-only CPR performed by a bystander can be just as effective as conventional CPR, which includes mouth-to-mouth, in the first few minutes of sudden cardiac arrest.

     “I was lucky to be around coaches who knew CPR and how to handle that situation,” Katarina Weigel, 21, said. She suffered from sudden cardiac arrest when she was 15 while warming up during volleyball practice at Yorktown High School in northern Westchester County.            

     “During jumping jacks, I just collapsed. Everything went black,” she said. “They immediately started doing CPR. They did three rounds of it until I convulsed and came back.”

     Weigel said after much confusion and hospital treatment, doctors said she had a rare genetic heart disease called catecholaminergic polymorphic ventricular tachycardia.

     “I thought, ‘No way, that’s not me. I’m a healthy athlete. There's no way I could have had this,’” she said. “Every student should know CPR because you never know what’s going to happen. If I was in the science wing and I dropped, I wouldn’t be here today.”    

     Michelle Cordova, Longwood High School’s head athletic trainer for nearly 24 years, said the school has its own safety policies as well.

     “There are emergency action plans for football, lacrosse and even for just when an injury happens that you need to have an ambulance called,” she said. Athletic trainers are responsible for the recognition, assessment, management and treatment of athletic injuries.

     Cordova said with the number of kids playing sports today, commotio cordis is more common than it used to be. “At any given day, I can have three or four games going.”

     She said that equipment is always progressing and evolving. “Whatever we can do to protect an athlete, we need to do.”

     The national standards committee says the chest protector performance standard will remain a proposal for at least one year. Oliver said this time frame allows the organization to meet and hear any critiques from the public and manufacturers.

     “Once we're satisfied, the board will then move it to final status, and at that point it’s an official standard,” he said. “Unless the governing body adopts it and incorporates it in their rules, it’s just a voluntary standard.”

     This thrills parents like Nancy Crowley. She said knowing there would be an official standard to protect her sons from another possibly fatal injury puts her mind at ease.

     “You get a glimpse of what it’s like to not have your child there,” she said. “To hear that there is something that actually may help is just wonderful. When I first heard, I was telling everybody, ‘We are all getting them.’”