BACKGROUND: The commotio cordis literature has largely focused on events 
occurring in the United States. However, with enhanced public awareness, 
commotio cordis has been increasingly recognized internationally as a cause of 
cardiac arrest and sudden death due to blunt nonpenetrating chest blows.
OBJECTIVE: This study sought to characterize the demographics of commotio cordis 
globally in comparison to the U.S. experience.
METHODS: This study used interrogation of the Commotio Cordis Registry 
(Minneapolis, Minnesota).
RESULTS: We report 60 cases of commotio cordis occurring outside the United 
States from 19 countries (most commonly the United Kingdom and Canada) on 5 
continents and compared these events to 2:3 occuring in the U.S. In the 2 
groups, events were largely similar demographically, including frequency of 
survival (26% in U.S. vs 25%; P = .84), and the striking male predominance 
evident in both groups (i.e., 95%), although non-U.S. victims were somewhat 
older (19 ± 13 vs 15 ± 9; P = .002). Not unexpectedly, the groups differed with 
baseball/softball and football predominant in the United States (55% of events) 
and soccer, cricket, and hockey most common internationally (47% of events). 
Notably, the frequency with which soccer participation caused commotio cordis 
was much more common than expected, particularly in non-U.S. athletes (20% vs 3% 
U.S.; P < .001).
CONCLUSION: Commotio cordis demonstrates a global occurrence, very similar 
demographically in the United States and internationally. However, the frequency 
with which chest blows from soccer balls caused commotio cordis events 
(particularly during sports played internationally) seems to contradict the 
prevailing notion that air-filled projectiles convey less risk for ventricular 
fibrillation than do those with solid cores (e.g., baseball or lacrosse balls).