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While announcing his return to football, Buffalo Bills safety Damar Hamlin said that commotio cordis was the cause of his cardiac arrest during a Monday Night Football game in January.

After presumably undergoing an extensive work-up, Hamlin that several specialists agreed on a diagnosis of commotio cordis, an extremely rare consequence of blunt force trauma hitting the chest at the wrong time, a miniscule 20-millisecond window out of a typical 1,000 milliseconds of a regular heartbeat.

Brandon Beane, the Bills general manager, on Tuesday said that physicians had to resume full football activities.

In order to reach the commotio cordis diagnosis, cardiologists would have excluded coronary artery-related or ischemic heart disease and any dissection or spasm of the arteries or some other kind of congenital anomaly in the heart's blood vessels. Electrical problems such as Wolff-Parkinson-White syndrome, long QT syndrome, or Brugada syndrome would also have to have been considered as potential contributors to cardiac arrest.

There were just 334 cases of commotio cordis from 1980-2022 registered in the National Commotio Cordis Registry, according to a statement from the American Heart Association (AHA).

Meanwhile, out-of-hospital cardiac arrest strikes -- including children and teenagers -- per a recent estimate. Furthermore, cardiac arrest is the leading cause of death for student athletes and sports-related sudden cardiac arrest accounts for nearly 40% of sudden cardiac arrests among people under the age of 18.

"Commotio cordis is an extremely rare event," said Gordon Tomaselli, MD, of Albert Einstein College of Medicine in New York City, in the AHA statement. "But if it occurs during a sports event with ready access to trained emergency care personnel and AEDs [automated external defibrillators], and CPR and defibrillation begin promptly, the survival rate is now quite good, in excess of 50%, which is a vast improvement to the less than 10% survival rate for most out-of-hospital cardiac arrests."

"In most cases, the individual affected is able to resume their previous life and activities," said Tomaselli.

Hamlin's medical team previously confirmed that athlete initially had a pulse when he was hit during the January game and fell to the ground. When he lost the pulse, responders started CPR, followed by a single defibrillation within minutes. Hamlin arrived at the hospital within 45 minutes of his collapse.

In the hospital, he was in the surgical intensive care unit and put on mechanical ventilation and aggressive targeted temperature management until he was extubated less than a week later.

"If there is some greater good that can come from his commotio cordis event, it is that as many people as possible are now aware of how important it is to provide urgent care for all cardiac emergencies -- everyone watching that night saw the chain of survival in action, successfully performed," said Nancy Brown, chief executive officer of the AHA, in the press release.

"Calling 911, and prompt CPR and defibrillation are essential to saving someone's life and optimal recovery. We strongly urge that at least one person in every household learn CPR and be ready to take action as soon as they witness someone having a cardiac emergency," she continued.

Since his recovery, Hamlin has been working with legislators to support the , a bill that would improve the response to sudden cardiac arrest in student athletes. If passed, the legislation would create a federal grant program for schools to purchase, maintain, and provide training for AEDs, to create athlete screening programs, and to strengthen cardiac emergency response plans.

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