How Cardiac Arrest Became a Household Topic After Damar Hamlin's Collapse

In January, we reported on Damar Hamlin’s collapse during a televised football game. In this report, we follow up on the resulting public interest on sudden cardiac arrest that made Hamlin the most searched person of 2023.

During the final Monday Night Football game for the 2022-2023 National Football League (NFL) season, all gameplay between the Buffalo Bills and Cincinnati Bengals came to a halt when Bills safety Damar Hamlin collapsed after getting hit while making a seemingly routine defensive tackle.

Live television coverage continued as trainers and medical staff ran on the field and started resuscitation efforts on Hamlin, then 24 years old. He reportedly had a pulse at first when he collapsed, but lost it, prompting responders to start CPR followed by a single automated external defibrillator (AED) shock within minutes. Hamlin arrived at University of Cincinnati Medical Center within 45 minutes of his fall.

In the hospital, he went to the surgical intensive care unit and was put on mechanical ventilation and aggressive targeted temperature management. He was extubated less than a week later and immediately started walking and undergoing physical therapy.

By April, the Bills general manager confirmed that Hamlin was fully cleared to resume football.

After much speculation by the public, Hamlin told reporters in April that several specialists agreed on a diagnosis of commotio cordis — an extremely rare consequence of blunt force trauma hitting the chest during a miniscule 20-millisecond window of a regular heartbeat — as the cause of his sudden cardiac arrest. In order to reach this diagnosis, cardiologists would have had to exclude ischemic heart disease, dissection or spasm of the arteries, some other kind of congenital anomaly in the heart’s blood vessels, and electrical problems such as Wolff-Parkinson-White syndrome, long QT syndrome, or Brugada syndrome.

The general consensus is that the athlete survived because of quick CPR and defibrillation. Generally, one in 10 people struck by out-of-hospital cardiac arrest die before reaching hospital discharge — though the odds of survival double or triple if CPR is performed immediately.

Hamlin made his return to the field in a preseason game in August. He was announced as this year’s most Googled person in December.

“I do believe that public awareness of signs of cardiac arrest and immediate next steps, such as importance of bystander CPR and access to AEDs, has increased over the past year,” commented Elizabeth Dineen, DO, cardiologist of Mayo Clinic in Jacksonville, Florida.

Before Hamlin’s televised collapse, a survey showed competitive athletes had a general limited awareness of sports-related sudden cardiac arrest and CPR. The survey included 104 collegiate athletes (37% female) at three sites. Only 50% reported knowing what sudden cardiac arrest is, and just over half had received CPR training.

This is despite sudden cardiac arrest not being a new problem in sports. Danish soccer player Christian Eriksen collapsed during a game in 2021 and was resuscitated on the field and later outfitted with an implantable cardioverter-defibrillator. In 1993, basketball player Reggie Lewis famously collapsed once during a game, later receiving conflicting diagnoses before returning to basketball and dying in a Boston Celtics practice gym.

Since Hamlin, athletes who have suffered cardiac arrests this year include college basketball player Bronny James, the Welsh soccer player Tom Lockyer, and the soccer player Raphael Dwamena from Ghana. All had reportedly received immediate medical attention after they collapsed, but the latter died.

“Overall, the high-profile sudden cardiac arrest events over the past several years have cast a spotlight on this problem. While highly impactful, sudden cardiac arrest in sport is not a new or worsening problem. In fact recent data just published out of the NCAA [National Collegiate Athletic Association] suggest that the incidence of sudden cardiac death in athletes is actually slightly lower now than in prior decades,” said sports cardiologist and echocardiographer Meagan Wasfy, MD, MPH, of Massachusetts General Hospital in Boston.

“Translating the attention paid to these events into action is the best way to protect the health of all athletes and the general public,” Wasfy said. “The most impactful step anyone in the public, including athletes, can take is to learn how to recognize sudden cardiac arrest and act as a bridge until medical help arrives using hands-only CPR.”

Indeed, since Hamlin’s recovery, there has been a slew of advocacy efforts for greater public awareness and funding for better preparation for these medical emergencies.

Hamlin has been the face of several campaigns by the American Heart Association (AHA) to raise awareness about cardiac arrest and the importance of prompt hands-free CPR. The AHA recently announced its goal to double the survival rate from sudden cardiac arrest by 2030.

The NFL Smart Heart Coalition was also founded in March after the Hamlin incident. The coalition had 37 partner organizations as recently as October, counting among them the AHA, American College of Cardiology, NCAA, and the National Basketball Association.

On the legislative side, Hamlin has also been advocating for the bipartisan Access to AEDs Act. The bill was introduced in the Senate in late March and, if passed, would create a federal grant program for schools to purchase, maintain, and provide training for AEDs, to create athlete screening programs, and to strengthen cardiac emergency response plans.

“[An] AED won’t do very well saving a life if it’s run out of battery, locked in back office far from practice or competition areas, etc. It is also critical that the emergency action plan has included key stakeholders, is rehearsed frequently and updated as needed, and includes other key elements that others have previously stated,” Dineen said.

“Legislative efforts on a more local/state level is where the rubber meets the road, and we have a long ways to go,” she told MedPage Today in an email.

In November, New York Governor Kathy Hochul signed state law S.7424/A.366A requiring camps and youth sports programs with five or more teams to have AED implementation plans and at least one person trained to properly use the device at camps, games and practices. She directly referenced Hamlin’s cardiac arrest in her announcement of the new legislation.