NFL player Damar Hamlin may have suffered an incredibly rare injury thought to affect just one in 264 million people, according to doctors.
The Buffalo Bills star collapsed with just over five minutes remaining in the first quarter of Monday's game (2 January) after hitting Bengals receiver Tee Higgins with what appeared to be a routine tackle.
While Hamlin initially got back to his feet, he then fell back on the grass and lay motionless, prompting medical staff to rush on to the field while other players from both teams took a knee.
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After medics administered CPR on the field, he was taken to the hospital at 9:25pm local time.
A statement issued by the Buffalo Bills a few hours after the incident said: "Damar Hamlin suffered a cardiac arrest following a hit in our game versus the Bengals. His heartbeat was restored on the field and he was transferred to the UC Medical Center for further testing and treatment. He is currently sedated and listed in critical condition."
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A number of doctors have since speculated that the star’s heart pumping mechanism was thrown out of rhythm when he received the blow to the chest, in turn disrupting the blow of blood around his body – including to his brain.
They believe this may have happened during a vulnerable point of the heart’s electrical cycle, which triggered a condition known as commotio cordis.
The condition is extremely rare, with a 2022 study saying there are fewer than 30 cases reported each year – with 7.9 billion people in the world, that’s the equivalent of one in every 264 million.
The study explains that it is a ‘ventricular fibrillation precipitated by blunt trauma to the heart’, and, while infrequent, it is ‘an important cause of sudden death in young athletes’.
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Dr Bernard Ashby, an Associate Professor at Florida International University, said it looked as though Hamlin had suffered the rare commotio cordis.
"The video of Damar Hamlin from a cardiologist's perspective resembled commotio cordis - a phenomenon that occurs when a sudden blunt impact to the chest causes cardiac arrest,” he wrote on Twitter.
“Timely defibrillation is life saving and prevents anoxic brain injury. I pray an AED was near.”
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Dr Deepak Bhatt, a cardiologist at Mount Sinai Heart in New York City, also echoed these comments in an interview with the Daily Mail.
He said: “The first thought that occurred to me was that it was something called commotio cordis.
“It really refers to the classic situation of injury to the chest.
“This is usually in baseball when someone hits a line into the pitcher's chest and that sudden impact can trigger abnormal heart rhythms.
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“The only way to come out of that is to deliver an electric shock and perform CPR.”
As for why he was able to stand up moments afterwards, Bhatt added: “It could be the case that for a couple of seconds there was enough blood getting to the brain.
“When the heart stops beating we lose consciousness within a matter of seconds. Those may have been the few seconds before the brain stopped getting enough blood.”
Jess Hardiman