'Golden two minutes': Player's cardiac arrest shows importance of immediate action

January 03, 2023
Social media post shows a blue jersey with the number 3 and the name Hamlin on it. There's a Buffalo Bills logo above the name.
A Twitter post from the Buffalo Bills shows a jersey with Damar Hamlin's number on it and an update on his condition.

Like football fans across the country, cardiologist Jeffrey Winterfield, M.D., had settled in to watch the Buffalo Bills take on the Cincinnati Bengals when he witnessed an event he called extraordinarily rare, involving Bills’ safety Damar Hamlin.


“I saw it happen. He’s a defensive player who took a helmet to the chest and stood up after the tackle and then collapsed within seconds of standing up.”


Fellow athletes were stunned, fans sat in silence and Winterfield watched something he knows a lot about play out in real time on TV. What looked like an ordinary tackle had accidentally triggered a potentially deadly response. When Hamlin tried to take down Bengals’ wide receiver Tee Higgins, Hamlin was hit hard in the chest and went into cardiac arrest.


Winterfield, who specializes in cardiac electrophysiology at MUSC Health – a field focusing on the electrical activities of the heart – knew time was of the essence.


“He very likely had cardiac arrest secondary to abrupt onset ventricular fibrillation. And speculatively, given the timing of the collapse within seconds of the hit to the chest, this is something called commotio cordis. That’s a Latin phrase for ‘agitation of the heart.’ It’s the second most common cause of sudden death in athletes. It typically occurs when a healthy heart is stopped suddenly just by a chance blow of sufficient force to the chest in between heartbeats.”


If the heart isn’t brought back into its proper rhythm quickly, the condition can kill. “The first two minutes are the golden two minutes,” Winterfield said, referring to the time immediately after cardiac arrest.


Jeff Winterfield, M.D. 
Dr. Jeffrey Winterfield

“The good news is the NFL has a rapid response program, which was executed in this tragedy. Within about eight seconds, trainers were on the field working on him. And CPR began within a minute or two, which is really critical. And if he had excellent CPR, which no doubt he did, coupled with rapid defibrillation with restoration of circulation, then the odds will hopefully be pretty good for him to survive this.”


Hamlin, 24 years old, arrived at the University of Cincinnati Medical Center in critical condition. His family has released a statement thanking people around the country for their support and asking for their prayers.


Cardiac arrest kills an estimated 300,000 people in the United States every year, according to the American Heart Association. The association said CPR can double or triple the chances of survival.


While cardiac arrest may sound like the same thing as a heart attack, Winterfield, an associate professor in the College of Medicine at the Medical University of South Carolina and the Hank and Laurel Greer Endowed Chair in Cardiac Electrophysiology, said it isn’t.


“A heart attack is a problem of coronary perfusion or an acute blockage of a coronary artery that results in a reduction in blood flow to the heart. It’s associated with symptoms like chest pain and shortness of breath, sometimes gastrointestinal distress, left shoulder pain, jaw pain. Those are classical symptoms of a heart attack.”


A heart attack can lead to cardiac arrest. But so can other factors – including a hard hit to the chest, Winterfield said.


“Cardiac arrest is the presence of ventricular fibrillation, which is erratic pulsating of the heart – kind of fluttering of the heart. If the heart is fluttering, it’s not mechanically able to generate the force necessary to create a pulse. As the heart’s resetting itself, if you hit the heart in between beats – at the wrong time – it can trigger that response.”


Social media post shows football players kneeling around an injured player. 
In this screenshot from Twitter, players and others connected with the team surrounded Damar Hamlin after he suffered cardiac arrest. An ambulance took him to the University of Cincinnati Medical Center.

Winterfield said it’s a phenomenon that never fails to stun onlookers. “This is something that happens maybe 20 times a year, usually in catchers in baseball and in lacrosse. A few years ago, a St. Louis Blues hockey player, NHL player, went down when he took a hockey puck to the chest. It was the same mechanism of injury on the ice.”

So people who work with athletes need to be aware of the risk, Winterfield said. “This has led, actually, to educational initiatives by the National Athletic Trainers Association. It’s important to be able to recognize the signs of commotio cordis and understand the need for prompt action. It encourages athletic organizations to provide education to coaches and parents for CPR and the use of automatic external defibrillators or AEDs. And then to identify the location of those AEDs. That’s available on the National Athletic Trainers Association website.”


But you don’t have to be a trainer or a doctor to know how to help. “I would encourage anybody interested in this to get CPR training and to learn how to use an AED,” Winterfield said.