Lacrosse Most Dangerous for Heart-Stopping Shots

After Cornell University defenseman George Boiardi was struck in the chest with a lacrosse ball in the closing minutes of a 2004 collegiate game, he collapsed to the turf, and his heart stopped. The shot he blocked had killed him.

It was literally a million-to-one shot, if not more unlikely. But in a sport as fast-growing as lacrosse, an event that uncommon will happen multiple times at the college and high school level, says a new study.

Overall, 23 lacrosse players in the United States have had the sport trigger sudden death or cardiac arrest since 1980. Four have survived the experience; the other 19 died. The likely cause in Boiardi's case, say researchers, was commotio cordis -- a condition in which an impact of blunt force arriving within a specific range of 15 thousandths of a second in the heart's beating cycle sends an electrical impulse to the heart, stopping it.

The researchers stress, however, that cardiac arrest remains rare in lacrosse.

"The message is that there are risks associated with sports in young people, but it does not appear that lacrosse, which is the fastest growing youth sport in America, is associated with excessive risk compared to other sports," said Dr. Barry Maron of the Minneapolis Heart Institute Foundation, the study's lead author.

The study appears in the most recent issue of Pediatrics.

While a slim majority of the deaths outlined in the study were from underlying heart conditions, commotio cordis -- which struck 10 times -- has drawn much of the attention, because death is likely preventable in many cases.

Twice in 2008 -- both at the high school level -- players blocked shots and suffered commotio cordis but were able to survive.

"When there were two episodes of commotio cordis on the field a year, a year and a half ago ... because these coaches recognized that this was a potential devastating injury ... they called for a defibrillator and both kids survived," said Dr. Jeff Mandak, a cardiologist in Harrisburg, Pa., and a member of U.S. Lacrosse's safety board.

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Mandak said that sudden death may never be fully preventable in lacrosse but that U.S. Lacrosse -- the sport's governing body -- has gone far to address the issue. A recreational lacrosse player himself, Mandak said he was invited to the safety board in 2000 by Steve Stenersen, president and CEO of U.S. Lacrosse, because of concerns about commotio cordis. U.S. Lacrosse organized a conference on the issue in 2007.

Of course, one of the main measures to avoid death by commotio cordis is to prevent it from occurring in the first place -- a function that is not served by available chest protectors.

Moran praised U.S. Lacrosse's safety efforts in that respect.

"U.S. Lacrosse has made a large effort to support the design of an effective chest protector," he said. "Lacrosse, in that respect, is unique among national sports organizations. They've promoted this idea and supported ongoing research to create such a chest protector. They've done that on their own volition. They should be congratulated on their efforts to make their sport even safer than it is."

There are several problems with existing chest protectors used in lacrosse. In two of the six cases of commotio cordis in the study that resulted in death (and four of the 10 cases overall), players were goalies wearing chest protectors.

"They never were developed to prevent internal organ injuries," Mandak said. "Now, we're looking at ways to develop that."

In addition to improper padding for internal organ injuries, chest protectors will shift when a player moves.

Stenersen said that following Boiardi's death in 2004, there was an increased push for all players -- not just goalies -- to wear chest protectors.

"It was not a panacea," he said. "The issue right now is that there is no chest protection in any sport that has been proven to eliminate commotio cordis."

In addition to U.S. Lacrosse's efforts to improve safety by getting better chest protectors and making coaches aware that they need automated external defibrillators on the fields, Dr. Margot Putukian, chair of U.S. Lacrosse's safety board and the director of athletic medicine at Princeton University, said that some changes in coaching might help as well.

In lacrosse and hockey, where commotio cordis has also been known to occur, players will often block shots by putting themselves between the ball or puck and the net. While often done at the professional level, it can be a difficult technique to master and often can lead to injury.

"To me, it just seems like there are issues there in terms of coaching," she said. "Kids need to know that they shouldn't do shot blocking in hockey when they're young. In lacrosse, it's the same thing."