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.

中文翻译：

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制定 NOCSAE 标准以降低 Commotio Cordis 风险

背景：心房颤动，即由相对无害的胸部撞击引起的心源性猝死（SCD），是运动中引起 SCD 的主要原因之一。商业护胸器尚未被证明可以降低这些 SCD 的风险。方法：为了制定评估护胸器的标准，分为 4 个阶段。利用生理性心震颤模型来评估预测 SCD 的变量。接下来，根据生理模型的数据开发替代模型，并评估风险的衰减。在第三阶段，对该模型进行了校准和验证。最后，国家运动器材标准运行委员会采纳了该标准，并进行了公开审查过程，并在三年多的时间里对该标准进行了修订。 结果：在所有变量中，冲击力在预测 SCD 方面最为稳健。胸壁保护器可以将冲击力降低到阈值以下，预计可以降低 SCD 的风险。实验模型与机械替代物之间的相关性范围为 0.783（速度为 30 英里/小时的长曲棍球）和 0.898（速度为 50 英里/小时的棒球）。该标准已获得国家运动器材标准运行委员会的许可，该委员会于 2018 年 1 月首次采用该标准，并于 2021 年 7 月最终确定。结论：基于完善的心颤模型的生理数据，可以使用有效的机械替代方法来预测心率的减少在带有胸部保护器的 SCD 中。力量的更大程度减少可以在很大程度上防止心震荡。这项新的国家运动装备标准运营委员会针对胸部保护器的标准应会显着降低运动场上发生心脏骚动的风险。