Development of the NOCSAE Standard to Reduce the Risk of Commotio Cordis.

IF 9.1 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Circulation. Arrhythmia and electrophysiology Pub Date : 2024-04-01 Epub Date: 2024-02-23 DOI:10.1161/CIRCEP.123.011966
Nathan Dau, Cynthia Bir, Elizabeth McCalley, David Halstead, Mark S Link
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Abstract

Background: Commotio cordis, sudden cardiac death (SCD) caused by relatively innocent impact to the chest, is one of the leading causes of SCD in sports. Commercial chest protectors have not been demonstrated to mitigate the risk of these SCDs.

Methods: To develop a standard to assess chest protectors, 4 phases occurred. A physiological commotio cordis model was utilized to assess variables that predicted for SCD. Next, a surrogate model was developed based on data from the physiological model, and the attenuation in risk was assessed. In the third phase, this model was calibrated and validated. Finally, National Operating Committee on Standards for Athletic Equipment adopted the standard and had an open review process with revision of the standard over 3 years.

Results: Of all variables, impact force was the most robust at predicting SCD. Chest wall protectors which could reduce the force of impact to under thresholds were predicted to reduce the risk of SCD. The correlation between the experimental model and the mechanical surrogate ranged from 0.783 with a lacrosse ball at 30 mph to 0.898 with a baseball at 50 mph. The standard was licensed to National Operating Committee on Standards for Athletic Equipment which initially adopted the standard in January 2018, and finalized in July 2021.

Conclusions: An effective mechanical surrogate based on physiological data from a well-established model of commotio cordis predicts the reduction in SCD with chest protectors. A greater reduction in force provides a great degree of protection from commotio cordis. This new National Operating Committee on Standards for Athletic Equipment standard for chest protectors should result in a significant reduction in the risk of commotio cordis on the playing field.

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制定 NOCSAE 标准以降低脐带损伤风险。
背景:心源性猝死(Commotio cordis),即胸部受到相对无害的撞击而导致的心脏性猝死(SCD),是导致运动中心源性猝死的主要原因之一。商业胸部保护器尚未被证明能降低这些 SCD 的风险:为了制定评估胸部保护器的标准,我们进行了四个阶段的研究。首先,利用生理学脐带损伤模型来评估预测 SCD 的变量。接下来,根据生理模型的数据开发了一个替代模型,并对风险的衰减进行了评估。在第三阶段,对该模型进行了校准和验证。最后,国家运动装备标准操作委员会通过了该标准,并对该标准进行了为期 3 年的公开审查和修订:结果:在所有变量中,冲击力对 SCD 的预测最为准确。据预测,能将冲击力降至阈值以下的胸壁保护器可降低 SCD 风险。实验模型与机械替代物之间的相关性从每小时 30 英里的长曲棍球的 0.783 到每小时 50 英里的棒球的 0.898 不等。该标准已授权给国家运动装备标准操作委员会,该委员会于 2018 年 1 月初步通过了该标准,并于 2021 年 7 月最终确定了该标准:基于一个成熟的脊髓损伤模型的生理数据,一个有效的机械替代物可以预测使用胸部保护器后 SCD 的减少情况。更大的力量减少可在很大程度上防止脊髓损伤。国家运动装备标准操作委员会关于护胸的新标准应能显著降低运动场上发生脊髓损伤的风险。
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来源期刊
CiteScore
13.70
自引率
4.80%
发文量
187
审稿时长
4-8 weeks
期刊介绍: Circulation: Arrhythmia and Electrophysiology is a journal dedicated to the study and application of clinical cardiac electrophysiology. It covers a wide range of topics including the diagnosis and treatment of cardiac arrhythmias, as well as research in this field. The journal accepts various types of studies, including observational research, clinical trials, epidemiological studies, and advancements in translational research.
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