‘A constellation of incredibly bad luck’ befell Bills safety Damar Hamlin, UB heart doctor says, but prognosis hopeful

By Scott Scanlon WNY Refresh Editor

Buffalo Bills safety Damar Hamlin was in the wrong place at precisely the wrong time Monday night when a blow to his chest short-circuited his heart and plunged him into cardiac arrest.

He was in a better place afterward, with trained professionals and rescue equipment at the ready, and a Level 1 trauma center within a 5-mile drive.

NFL brass, players and fans may need to wait another day or two for a better sense about how things play out for Hamlin, but a leading Buffalo heart doctor was hopeful Tuesday that things look promising based on what so far is known.

“I think the fact that they restored his normal heartbeat on the field before he went to the hospital is an encouraging sign,” said Dr. Anne B. Curtis, a cardiac electrophysiologist who nearly five years ago helped develop guidelines to manage patients with ventricular arrhythmias and prevent sudden cardiac death.

Curtis is not involved in treating Hamlin, 24, a second-year pro with the Bills, but said everything she has seen and read so far tells her that his treatment is going according to established protocol.

Once a patient is stabilized after sudden cardiac arrest, they are often intubated and their body temperature deliberately cooled, slowing it down so a patient can regroup while specialists start to screen for damage.

<p>Dr. Anne B. Curtis, a Buffalo cardiac electrophysiologist who helped develop guidelines to manage patients with ventricular arrhythmias and prevent sudden cardiac death, says treatment looks promising for Buffalo Bills safety Damar Hamlin based on what so far is known.</p>

Sandra Kicman/UB Jacobs School of Medicine and Biomedical Sciences

Dr. Anne B. Curtis, a Buffalo cardiac electrophysiologist who helped develop guidelines to manage patients with ventricular arrhythmias and prevent sudden cardiac death, says treatment looks promising for Buffalo Bills safety Damar Hamlin based on what so far is known.

It’s possible, but unlikely, she said, that Hamlin can communicate during this process, which typically lasts 24 to 36 hours, as it did in September 2007, when Bills tight end Kevin Everett, then 25, suffered a serious neck injury on a kickoff return.

Everett was partially paralyzed during that hit but eventually regained his ability to walk.

A horrific injury

Should Hamlin survive his cardiac arrest – and had no underlying heart condition – he may well return to good health, Curtis said Tuesday morning.

Cardiac arrest is caused when the electrical system in the heart malfunctions. A heart attack – the blockage of a coronary artery – and almost any known heart condition can cause the heart to stop.

So can damage to the heart directly, including a sharp, sudden blow.

Such an injury, called commotio cordis, is very rare, said Curtis, a SUNY distinguished professor in the Department of Medicine at the University at Buffalo Jacobs School of Medicine and Biomedical Sciences.

“It’s basically a constellation of incredibly bad luck …,” she said. “You can have a totally normal heart and have this happen.”

More than 350,000 cardiac arrests occur outside a hospital in the U.S. each year, according to the American Heart Association.

CPR should start immediately and can support the body’s circulation while the cause of the cardiac arrest is corrected, Curtis said. A defibrillator delivers a shock that can immediately restore the heart’s normal rhythm.

“If the patient is in ventricular fibrillation, CPR is paused very briefly so the electric shock can be delivered,” she said. “If it is unsuccessful, CPR resumes.”

Both measures, along with oxygen, were administered to Hamlin at Paycor Stadium before he was taken by ambulance at 9:25 p.m. Monday to University of Cincinnati Medical Center, according to broadcast reports following the injury Monday night.

The Buffalo Bills reported early Tuesday that Hamlin was sedated and said Tuesday afternoon he remained in critical condition in the hospital’s intensive care unit.

Hamlin would have been sedated if trauma specialists put him into a state of hypothermia, Curtis said. They will have a much better idea of his condition as they slowly warm his body temperature, which could start late Tuesday or sometime Wednesday.

“Then you’re looking to see if somebody wakes up and could communicate with you, if there are any signs of neurological injury,” she said. “There are certain parts of the physical exam you can do that might give an indication as to whether there is any brain damage.

“The best way to tell is after a patient’s warmed up. Then you can stop the sedation and see if they respond. See if they come to, see if they can follow commands and then eventually verbalize where they are … so I wouldn’t say lack of communication today was a bad sign.”

‘Freak accident’

The heart needs an electrical system to tell cardiac muscle cells when to contract, first in the upper chambers, then in the lower.

Typically, the heartbeat works at 60 to 100 beats per minute at rest, a bit lower during sleep and up to 150 beats a minute during exercise.

It only takes a fraction of a second for the heart to go dangerously out of rhythm, a process called ventricular fibrillation.

“In order for a blow to the chest to cause somebody’s heart to fibrillate, and then potentially kill them, it has to be a precisely located blow to the lower left chest, right over the heart itself, and precisely badly timed,” Curtis said. “The window that’s been studied says it’s a 30-millisecond window. Think how small that is.”

What does Hamlin’s injury say about the inherent dangers of football and the NFL?

“Football has lots of other problems with contact, but this one is really very, very unusual,” Curtis said. “I don’t think it’s a reason to worry, not to play. Everybody’s saying that this is the first time it’s happened on a football field like this and yet there’s contact with the sport all the time.” 

Commotio cordis, while rare, is more common from hitting the steering wheel at just the wrong angle if an airbag doesn’t deploy during a car crash.

It’s also occurred in sports including baseball, hockey and lacrosse, where projectiles travel at high speeds and sometimes strike players.

St. Louis Blues Hockey Hall of Famer Chris Pronger, for instance, collapsed on the ice during the 1998 Stanley Cup finals when he got hit in the chest with a puck from a slapshot fired by Detroit Red Wing Dmitri Mironov. Pronger’s heart skipped a beat and he lost conscious for 20 seconds, an outcome far less serious than what NFL viewers saw this week on “Monday Night Football.” The Blues lost that series, but Pronger’s career continued.

Stressing that she is unfamiliar with specifics of Hamlin’s case, Curtis expressed hope for his future.

“The best-case prognosis is he comes back completely normal,” she said, “and I think that there’s a real chance of that because of the prompt attention he got on the field.”

Brain damage, disorientation or poor memory could surface this week, or signs of a heart condition, Curtis said, “but it’s not going to be like a stroke where one side of the body is paralyzed or anything like that. I would say most of the time, you’re gonna see the rest of the body be okay.

“It’s a matter of neurologically, does he come back all the way? Another important point is just because it’s happened to him like this, it doesn’t put him at higher risk any other time because it’s basically a freak accident.”

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