BACKGROUND: Commotio cordis events due to precordial blows triggering 
ventricular fibrillation are a cause of sudden death (SD) during sports and also 
daily activities. Despite the absence of structural cardiac abnormalities, these 
events have been considered predominantly fatal with low survival rates.
OBJECTIVE: To determine whether expected mortality rates for commotio cordis 
have changed over time, associated with greater public visibility.
METHODS: US Commotio Cordis Registry was accessed to tabulate frequency of 
reported SD or resuscitated cardiac arrest over 4 decades.
RESULTS: At their commotio cordis event, 216 study patients were 0.2-51 years 
old (mean age 15±9 years); 95% were males. Death occurred in 156 individuals 
(72%), while the other 60 (28%) survived. Proportion of survivors increased 
steadily with concomitant decrease in fatal events. For the initial years 
(1970-1993), 6 of 59 cases survived (10%), while during 1994-2012, 54 of 157 
(34%) survived (P = .001). The most recent 6 years, survival from commotio 
cordis was 31 of 53 (58%), with survivor and nonsurvivor curves ultimately 
crossing. Higher survival rates were associated with more prompt resuscitation 
(40%<3 minutes vs 5%>3 minutes; P<.001) and participation in competitive sports 
(39%; P<.001), but with lower rates in African Americans (1 of 24; 4%) than in 
whites (54 of 166; 33%; P = .004). Independent predictors of mortality were 
black race (P = .045) and participation in noncompetitive sports (P = .002), 
with an on-site automated external defibrillator use protective against SD (P = 
.01).
CONCLUSIONS: Survival from commotio cordis has increased, likely owing to more 
rapid response times and access to defibrillation, as well as greater public 
awareness of this condition.