The 24-year-old was administered CPR on the field, ESPN reported during the broadcast. Hamlin was treated on the field by team and independent medical personnel and local paramedics. He was taken by ambulance to the University of Cincinnati Medical Center.
Dr. David Montgomery, a board-certified cardiologist and host of “Dr. TV,” offered his insight into what he saw examining the hit and said he thinks there are two distinct possibilities.
“One is what we’ve been hearing about, which is that there is a sudden contact to the chest and impact to the chest that causes a chaotic rhythm to happen and the heart stops beating. We call that commotio cordis; it’s Latin, it just means commotion or chaos in the heart rhythm,” he explained.
“The other distinct possibility is that when he sustained the impact, that he got a blow to the chin, the chin then referred back into the brain and causing sort of an acute traumatic brain injury.”
Montgomery said while it is rare, someone can have a traumatic cardiac arrest in seconds to minutes after a severe enough traumatic brain injury.
Dr. Corey Hébert, with the Louisiana State University School of Medicine, also hypothesized commotio cordis.
“So what happens is that you have a blunt force trauma to the left side of the chest, and that’s over the heart. That will disrupt the myocardium just enough so that the electrical impulses will be distributed unevenly throughout the myocardium, which makes the heart go into a really horrible arrhythmia called ventricular fibrillation, which means that the heart isn’t working appropriately,” Hébert explained.
He said commotio cordis happens in young people playing sports because younger athletes increase the time that they’re playing sports.
“Young boys, because their chest wall is usually thinner, will allow that impact to affect the heart muscle just a little bit more than a big athlete who has a big pectoral muscle,” Hébert said. “These men, as you can see, they always have on chest protection in the form of shoulder pads. So it’s just the right hit at the wrong time, at the exact moment that can disrupt this heart. That’s why it doesn’t happen all the time. But the possibility of it happening is a lot more than we think.”
Hamlin was hurt while tackling Bengals receiver Tee Higgins on a seemingly routine play that didn’t appear unusually violent.
“The blow doesn’t have to be that harsh; it doesn’t have to be that severe. We’ve known about this for hundreds of years because there was actually an Asian fighter that would term it “the touch of death,” Hébert said. “If you time it just perfectly and hit the heart in such a way to make that be fit happen, then the ventricle will not fill and that oxygenated blood which is in the left ventricle will not be dispersed to the body. And that is when you don’t have oxygen and you have cardiac arrest, and that is what we think probably happened here with this young man.”
Higgins was running with the ball on a 13-yard pass from Joe Burrow when he led with his right shoulder, hitting Hamlin in the chest. Hamlin then wrapped his arms around Higgins’ shoulders and helmet to drag him down. Hamlin quickly got to his feet, appeared to adjust his face mask with his right hand, and then fell backward about three seconds later and lay motionless.
Hamlin was down for 19 minutes while receiving medical attention. WXIX-TV in Cincinnati reported that Hamlin required an automated external defibrillator (AED) in addition to CPR on the field. CPR was performed for nine minutes.
“It doesn’t tell us about the cause. But it does tell us that it sort of ended in cardiac arrest. There are so many different things that can cause cardiac arrest, including chronic conditions — maybe that he didn’t know about — this commotio cordis, and then this rare sort of traumatic cardiac arrest after a brain injury,” he explained. “So, the fact that it took nine minutes to I think, get him to recover his own heartbeat, what we call the recovery of spontaneous contraction, does have some prognostic value.”
Montgomery also noted that Hamlin’s medical or cardiac history wasn’t known and he may have had things that he didn’t know about.
“You can have cardiac problems like structural heart disease, and not have any symptoms until something like this. So they’re things like genetic rhythm abnormalities, they’re things where your heart, for example, as a response to a genetic abnormality, can get thicker, what we call HCM or hypertrophic cardiomyopathy that can cause stuff like this, we’ve seen this in different sporting events,” he explained.
“Then there’s a number of other medical conditions that then can converge and cause a cardiac arrest, especially after a stressor like you know, getting ready for a big game, and then sustaining even a bit of a mild blow.”