Experts: Next 24 hours critical in Damar Hamlin's recovery

Experts say the next 24 hours will be critical in the recovery of Damar Hamlin, the Buffalo Bills safety and McKees Rocks native who suffered cardiac arrest during a “Monday Night Football” game at Cincinnati.

“It’s hard to say exactly what’s going on. But at this point, they are maintaining his heart rhythm, maintaining his blood pressure and slowly looking for signs of brain activity,” said Dr. Indu Poornima, cardiologist and director of preventive cardiology and quality officer of Allegheny Health Network’s Cardiovascular Institute. “Typically, when a patient has a cardiac arrest and the brain doesn’t work and your ability to breathe also stops, you are placed on a ventilator. The patient is kept significantly sedated because we want the brain to slowly recover function.

“If the patient is able to take spontaneous breaths, (beyond the ventilator), that’s a good sign. The breathing is coming back. Then there are things we look for — if the pupils are reacting to light appropriately and motor movements — but that will be down the line. We don’t have updates on the (heart) rhythm. If the rhythm has been stable, that’s, obviously, a good sign.”

Hamlin, a former Central Catholic and Pitt star, collided with Bengals wide receiver Tee Higgins while making a tackle during the first quarter. He stood up, then collapsed.

Hamlin was administered CPR on the field, ESPN reported. In all, Hamlin received medical treatment for 20 minutes on the field.

Hamlin’s heartbeat was restored, and he was taken by ambulance to the University of Cincinnati Medical Center, where he was in critical condition and sedated, according to a statement from the Buffalo Bills.

The game was suspended and will not be resumed this week, the NFL said Tuesday.

Cardiac arrest occurs when the heart stops beating, said Dr. Tamanna Singh, co-director of the Sports Cardiology Center at the Cleveland Clinic.

“Basically, once that happens, if you can’t maintain oxygen delivery, blood perfusion, to your vital organs including your brain and your heart, you could die,” Singh said.

She said the first thing doctors responding in that situation want to do is assess whether the player is breathing. They check to see if there is a pulse.

“If they do not have a pulse — and this is speculation, but just based upon what we’ve seen in the media — the next immediate step you want to take is to try to reinitiate cardiopulmonary perfusions. What does that mean? Starting CPR. Immediately starting chest compressions, getting an automated electric external defibrillator, which is a device that can shock the heart back into a normal rhythm or restart the heart,” Singh said. “Those are probably the two biggest things that they were doing immediately on the field.”

The key takeaway, according to Singh, is that if a player goes down, doctors must assess whether the person has a pulse and whether they’re breathing.

“Typically, when patients lose their pulse, they are oftentimes also not breathing,” Singh said.

Related

• Mike Tomlin reflects on 'love and respect' for former Central Catholic, Pitt star Damar Hamlin
• Damar Hamlin's family releases statement thanking everyone for support
• Pittsburgh native Damar Hamilton in critical condition after collapse on field

At that point, Singh said doctors check the airway to determine whether the patient requires a breathing tube.

“The amount of time with a lack of blood flow to the vital organs is going to determine complications,” she said. “Those chest compressions, you are actually mechanically pushing the heart to pump instead of the heart pumping on its own. If you can do really high-quality CPR chest compressions, then, theoretically, you are able to prevent damage.”

Hamlin would not have been aware of what was happening to him, Poornima said.

Singh said the next thing that should happen is figuring out what caused the cardiac arrest.

“Those causes can include a structural abnormality, something intrinsically wrong with the heart muscle that somehow provoked perhaps an abnormal heart rhythm, cardiac arrest,” Singh said. “Once you can identify the cause, you can rapidly treat it.”

Excela Health cardiologist Dr. Larry DeNino said the most likely cause of Hamlin’s collapse was a disruption of heart rhythm called commotio cordis, which in Latin means “agitation of the heart.” It happens as a result of a blow to the area directly over the heart at a critical time during the cycle of a heartbeat.

“That was my No. 1 thought when I saw what happened,” DeNino said. “He didn’t fall like a chopped tree. He just kind of slowly crumpled to the ground.”

Singh said if Hamlin was given CPR quickly enough, a strong recovery is possible. He might even be able to play pro football again.

She said his recovery comes down to some key questions:

“Is he neurologically intact? Is he speaking OK? Is he moving OK? Has there been any damage in that regard? Is he going to require rehabilitation, whether it be physical or cognitive? Depending upon the cause of the cardiac arrest, what implication is that going to have on his ability to play professionally? Is he going to be on medications?” Singh said. “All those things are going to impact how long he would be out from sport and how long his road to recovery will be.”

UPMC officials were contacted for comment but declined.

Senior public relations manager Cyndy Patton provided this statement: “In deference to our close partnership with the Pittsburgh Steelers, it would be inappropriate for us to comment or speculate on the medical condition of any NFL player receiving treatment outside of our care.”