InsideSurgery.com is following with concern the collapse and cardiac arrest suffered by Buffalo Bills player Damar Hamlin during what looked like a routine hit during a game against the Bengals on Monday night. While we are not involved in the care of Hamlin we have noted developments through media reports.
The actual collapse of the Hamlin appeared off the main broadcast shot but he apparently looked to be involved in a routine tackle of not particularly unusual force. He then popped up and took a step or two backwards and collapsed onto his back. Reports are now that he suffe4red a cardiac arrest.
InsideSurgery editors are fellowship trained in critical care medicine with many thousands of hours attending in both medical and surgical cardiac units. Some observations are below:
It appeared from the telecast that the Bills trainers were on the scene within a few seconds but did not immediately assess for cardiac status. This is done by feeling for a pulse in the carotid artery at the side of the neck. It was about 30 seconds before the national telecast cut to commercial and our editors did not see any attempt to evaluate for this. In assessing unconscious patients you would first assess airway, then breathing, then circulation with can be done in ten seconds.
Cardiac arrest is a catchall term for the heart stopping but does not give much information about what caused it. Regardless of cause, the algorithm to treat is the same. Once it is established that there is a pulse or absence of a pulse the protocol begins. If there is no pulse chest compressions must start immediately. In the previous years this was always accompanied by mouth to mouth resuscitation but data has shown in the last several years that the most important factor is to have blood being ejected from the heart. This is accomplished by chest compressions of at least 60 a minute. This was not started immediately and should have been.
The second most important thing to do is to effect cardioversion by shocking the heart back into a normal rhythm. If Hamlin was suffering from an electrical disturbance in the heart causing arrest as opposed to a clot occluding an artery or a dissected coronary artery, this is doubly important. Every NFL sideline has an Automated Electrical Defibrillator or AED. This should have been on Hamlin within 60 seconds. Once there was no pulse detected, compressions should have started and the AED should have been sprinted onto the field.
NFL trainers are taught to look for and assess orthopedics injuries, not cardiac disturbances. However, there should have been physicians on the sidelines who should have immediately stepped in.
Every second a patient is in a state where his heart is not pumping is killing brain cells. This is really a case where seconds count.
It is possible that the tackle had nothing to do with the arrhythmia suffered by Hamlin. His underlying health status will be assessed to check for genetic predispositions for irregular heartbeats. He may have had a case of Covid that predisposed him or other infectious diseases like Lyme disease that are associated with heart block.
Reports are that he is sedated and in the ICU. Cincinnati has excellent tertiary care hospitals so his hospital care would be expected to be topnotch.
He is likely undergoing a full battery of laboratory tests, an esophageal echocardiogram to bounce sound of the structures of the heart to see how well it is pumping and to look for abnormal anatomy, placement of a temporary pacemaker, and a possible cardiac catheterization to check for coronary artery disease.
If the cardiologists have assessed that resuscitation efforts in the field were delayed and are worried about brain damage, he could be undergoing medical cooling to place him in a deep coma to protect brain cells who are borderline but potentially can be saved.
If he is being medically cooled he will be in a deep coma for at least 24 hours and then slowly rewarmed. He will likely be hospitalized for a minimum of several days. But, modern day cardiac rehab has shown that getting the patients out of bed and moving improves outcomes.
It is unclear at this time as to whether he will be able to resume his football career. Unfortunately, data are emerging that young people, particularly young athletes who have had Covid are at increased risk of early cardiac events and death. There have been multiple reports in the last several years of young, well-conditioned athletes suffering heart attacks on the playing field.
His doctors will have to look carefully at this history. It is entirely possible that Hamlin’s collapse had nothing to do with the tackle and was coincidental to the play.