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Aug 30, 2023

How Does Cardiac Arrest Happen to a Young Athlete Like Damar Hamlin?

By Korin Miller The country is still in shock after Buffalo Bills safety Damar

By Korin Miller

The country is still in shock after Buffalo Bills safety Damar Hamlin suddenly collapsed on the field during the first quarter of his team's game against the Cincinnati Bengals Monday night. About nine minutes into the game, the 24-year-old athlete was hit during a play. He then stood up, nearly instantaneously, and fell to the ground seconds later. A tweet from the official Buffalo Bills Twitter account confirmed that Hamlin "suffered a cardiac arrest following a hit."

Standby medical personnel quickly administered CPR to Hamlin for 10 minutes before he was placed on a stretcher and taken to the University of Cincinnati Medical Center in an ambulance, according to The New York Times. Hamlin's heartbeat was "restored," per the tweet from the Buffalo Bills; he is currently listed in critical condition.

Members from both teams were understandably emotional after Hamlin collapsed, and the game was eventually postponed. "Neither coach was talking about resuming play, the players were not thinking of resuming play," Troy Vincent, the NFL's executive vice president for football operations said, per The New York Times. "How do you resume play after seeing such a traumatic event?" (Worth noting: The NFL quickly came under fire for how long officials took to call off the game.)

If you witnessed the incident, you probably had one major question: How does something this sudden and devastating happen to a seemingly healthy, young athlete? Ahead, experts explain the potential causes of cardiac arrest in a situation like this—and what the road to recovery may look like.

First, it's important to note that Hamlin's medical history is between him and his doctors—and there's no way to know what, exactly, trigged this incident without the input from his care team. That said, there are various established causes of cardiac arrest to be aware of, as well as a history of sudden cardiac arrest in athletes that's worth exploring.

Cardiac arrest means the heart abruptly stopped functioning, according to the American Heart Association (AHA). It happens when the heart's electrical system malfunctions and the heart stops doing its job of pumping blood. This is a serious medical emergency, according to the National Heart, Lung, and Blood Institute (NHLBI), as 9 out of 10 people who experience cardiac arrest outside of a hospital setting die, typically within minutes.

"When the heart stops pumping, no blood is going to the brain or body, so the victim suddenly collapses," Holly S. Andersen, M.D., attending cardiologist and associate professor of clinical medicine at the New York-Presbyterian Hospital, Weill Cornell Medical Center. In this scenario, a person may pass out, stop breathing, or lose their pulse.

The AHA says the potential causes of cardiac arrest vary greatly but can be triggered by nearly any known heart condition, like cardiomyopathy, scarring of the heart tissue, arrhythmia, heart valve disease, and electrical abnormalities, among many others.

Half of the reported cardiac arrests in the United States actually happen in people who didn't know they had a heart problem, per the NHLBI. In young athletes, for example, a cardiac arrest may be triggered by a congenital heart defect, which refers to a heart abnormality that developed before birth, Ronald Maag, MD, assistant professor of medicine and medical director of the Baylor Heart Clinic in Houston, tells SELF. "It could be that there was something that was missed over time," he explains.

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It's also possible that blunt trauma to the chest could trigger a rare condition called commotio cordis: It occurs when a sudden blunt impact—say, from a ball, helmet, or generally powerful human—hits the chest at just the right time in just the right spot to trigger an unstable heart rhythm, Dr. Maag says.

Unfortunately, research suggests that cardiac arrest is the top cause of sudden death in young athletes, and Black men have a higher risk, Dr. Andersen notes, adding that "football players and basketball players are the most affected." It can happen in seemingly healthy athletes with undiagnosed heart conditions or in those with healthy hearts.

Hamlin's situation is devastating to his family and fans, but he, thankfully, received the best treatment as quickly as possible. Typically, that involves CPR (cardiopulmonary resuscitation) with defibrillation, which is an electric shock that aims to restore the heart's rhythm, Carlos Ince, MD, a board-certified cardiologist at Baltimore's Mercy Medical Center, tells SELF. Having a "witnessed cardiac arrest" (meaning people were around to see it happen) is a "best-case scenario" because people—in Hamlin's case, highly qualified paramedics—can jump into action to help.

"A witnessed arrest with downtime usually is treated with hypothermia—chilled body temperature—to preserve brain function," Dr. Ince says. A person will also usually be intubated to help them breathe and get enough oxygen.

Once a person's heart rhythm is restored, doctors will then try to figure out why the cardiac arrest happened in the first place. "Once you find out why this happened, you try to treat that underlying cause," Dr. Maag says. "That involves lots of imaging of the heart to see if it was normal." If medical staff determine that a person's cardiac arrest was caused by blunt trauma, for example, they’ll try to figure out if someone is at risk of it happening again.

The patient will also undergo testing on the electrical capacity of their heart and their arteries, along with neurological testing to determine if their brain was impacted by the lack of blood flow, Larry Phillips, MD, a cardiologist at NYU Langone Health, tells SELF. "There are different types of tests that are done to look for movements, mental status, their alertness. They’re all very comprehensive exams," he says. Overall, treatment is "so dependent" on the individual, Dr. Maag stresses.

If a person survives, it's possible to resume a healthy, active lifestyle after experiencing cardiac arrest, "particularly if it is commotio cordis, which is almost a freak accident," Dr. Ince says.

That's why Dr. Andersen urges people to learn CPR, just in case. "[Damar Hamlin] will not remember what happened," she says. "For those of us who watched, we will never forget. Be prepared to save a life."

In a statement shared on Twitter, Hamlin's family said they are "deeply moved" by all the "support shown during this challenging time," adding, "We will share updates as soon as we have them."

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