What was a doctor’s first reaction to what happened on MNF?

Dr. Salen Perec, friend of ours, long time with Duke University, now with Rothman Orthopedics in New Jersey.

He is our official Adam Goldsho physician. First of all, I would much rather be talking to you about why you move closer to your Yankees, but let's deal with what we saw last night. I don't know, first, your first reaction to what we saw is appropriate, but let me just start there and we'll work our way forward. Yeah, I mean, my first reaction was that, you know, when you first saw the tackle happen and then Demar stands up and then it collapses right away. From my perspective, right away, I was thinking something with his heart. And then to see the ensuing things that occurred and the reactions from the players who knew this was bad. It was a very somber mood.

Yeah, I agree. That was also my first reaction was that this was beyond, I think the initial reaction from a lot of people was a concussion, but this had none of the hallmarks of that. So I know you tried to explain to me what may have happened. And again, we have not had a statement from the University of Cincinnati Medical Center Center, but basically explain to our audience what is your best guess as to what happened to him from what was seen on TV and also what was released by the NFL that that Demar had a cardiac arrest episode, meaning his heart stopped beating.

Now, why this happens? There are a lot of different reasons, but in the setting of what we saw, this is most likely due to something called commotio cordis, Latin words, meaning that he had a blow to the chest wall, right overlying his heart in a specific area that is over one of the biggest parts of your heart called a left ventricle, which is one of the big pumps that pumps the blood to the rest of your body. And so he took a helmet right in that area and getting that hit right in that area with the heart rate, heart going through a specific part of the pumping cycle, getting it at a certain time point in that cycle, that's how you get this heart rate or the heart stop pumping and to basically go with cardiac arrest. So it's a rare thing to happen where you take a blow to the chest wall in the right spot, just the right time of the cardiac cycle to get the heart to stop beating. You typically see this more often in baseball or lacrosse or even hockey where the, what hits the chest wall is very hard and in this case is the helmet.

So it's just a combination of weird events, but I think this is what it's going to come out that he had commotio cordis and that caused the heart stop pumping. I mean, I can't even venture a guess as to how many games, and I know you're a big sports fan as well, how many games that I have seen over the course of my life. I mean, I watch a hundred hurricanes games a year.

I've been personally to about 250 baseball games. I have never seen something like this, which is why it was such a shock to so many people. I mean, I don't even know. The hit didn't even look that, we see much worse hits on a game in game out basis than what that play was. It almost seems like this is an absolute freak occurrence. It is a freak occurrence and you don't have to be hit hard.

So there's actually been some research looking at this. You only have to be hit about 25 miles per hour to the chest. So you're not talking about a really high velocity hit that causes this kind of injury.

But again, it's not only the velocity, but it's the location and the timing in the heart pumping cycle. All those things have to line up for him to have this happen. It's freakishly rare. Yeah. Again, I can't even fathom a guess as to how many games I've seen in my life to even come up with a set of odds as to what the chances are of something like this. What is the prognosis? It's very difficult probably for you to even guess here, but the prognosis for recovery for something like this, it would seem like he was fortunate that the emergency medical equipment was so close by because I would imagine when this happens, it's largely fatal.

Yeah. So it's hard to know prognosis in this specific case just because there's so many factors. But just like you said, one of the biggest factors is the time to do CPR. And it's been shown that if you get to CPR within three minutes, then you have a higher success rate of keeping this person alive.

And so if you go beyond that, the death rate can sometimes be upwards of 80%, the fatality rate. So the fact that he had CPR initiated so quickly that so many medical staff were right there so fast is probably the best case scenario for him. And then having the AED available to do the automatic electrical defibrillation is important too, to kind of shock his heart into getting back into a normal beating rhythm. And we know, at least when it was released by the NFL, that he had a pulse on the field. Those are all great signs for him to survive. But the other part of this is brain function. And for every minute that they are administering CPR, there is a higher hit rate to the brain.

And that we don't know yet. And we likely won't know his brain function or his brain damage level for four or five, six days, even a week. Dr. Salem Perec, before I let you go, and I appreciate your time, Dr. Salem Perec, MD on Twitter. Assuming that there is no brain damage, are we talking about, and this is probably inconsequential, but I think people are wondering, are we talking about somebody whose career is over or can he make a full recovery and get back to play? So he can make a full recovery to functional life.

Absolutely. But I think that you would, I think from my perspective, if I were involved in this care, I would highly suggest that he stop football. And the reason is, yes, this is a freakishly rare condition. A lot of things have to line up, each of which is extremely rare for this to occur. But now you've had it happen once. As a safety, you're going to take more and more blows to that chest wall every single game, whether you're involved in that tackle or you're just getting blocked. So your exposure to that risk is high. I'm not sure it's really worth it.

And I think the party line in medicine would be stop all contact sports. Dr. Salem Perec, I appreciate your time. You know how much I'm first of all, I miss you living in Jersey now, but I don't have any time. We can watch the Yankee game. I don't want to watch the Yankees. I'm not even sure I want to watch the Mets, but I will talk to you very soon. Thank you very much for your time.