ECMO-/ECLS

abnormal EKG and hemodynamically instability to look for structural cardiac
pathology, such as impaired wall motion or valvular dysfunction.
Management of blunt cardiac injury is essentially supportive care.
Hemodynamically stable patients with a normal EKG require no further
evaluation or intervention and may safely be discharged home. An abnormal
EKG, on the other hand, merits admission for cardiac telemetry and
observation for 24-hours. Hemodynamic compromise not associated with other
injuries necessitates further evaluation with echocardiogram and transfer to an
intensive care setting.
Commotio cordis, which means “agitation of the heart” in Latin, refers to
sudden cardiac death from a non-penetrating precordial chest wall blow in the
absence of an identifiable structural injury to the chest wall or heart. This is the
second leading cause of young athletes and has been reported in sports such
as baseball, basketball, hockey, football, and lacrosse. This devastating
condition occurs most frequently between 7 and 16 years of age. Although the
mechanism is not clearly understood, it is postulated that a blunt impact in the
precordial region of the chest wall during a vulnerable period of cardiac
repolarization can trigger ventricular fibrillation and, consequently, sudden
death. According to the National Commotio Cordis Registry, survival rates from
commotio cordis between 1970 to 1993 were a dismal 10% to 15%. However,
with increasing awareness, early activation of emergency medical services, and
increased availability of automated external defibrillators (AED), survival rates
have improved between 2006 and 2012 to 58%.