University of Iowa ER doc, Chicago Cubs physician calls Damar Hamlin response ‘fantastic’

Treating a patient in cardiac arrest is stressful for any emergency room doctor — charged with deploying years of training alongside peers doing the same in a setting stocked with equipment needed to save the person’s life.

Now consider doing that in a stadium of 65,000-plus, before a live audience of more than 23 million — like doctors did this week in Cincinnati when Buffalo Bills safety Damar Hamlin collapsed in cardiac arrest during “Monday Night Football.”

“That's a whole different level of stress on an already stressful situation,” University of Iowa clinical associate professor of emergency medicine Christopher Hogrefe told The Gazette, pulling from personal experience as a current assistant physician for the Chicago Cubs.

“Personally, I can empathize with them,” said Chicago-based Hogrefe, who over the course of his career also served as a visiting team physician for the Chicago Bears and an emergency physician at Chicago Blackhawk games. “They did fantastic to get him stabilized, get his heart restarted … get him to a major academic center.”

Hamlin, 24, remained in critical condition Thursday but — according to a team statement — was showing signs of “remarkable improvement” after collapsing during Monday’s game following what appeared to be a routine hit.

Having spent more than a decade in emergency and sports medicine, Hogrefe — who also holds an adjunct associate professorship at the Northwestern Feinberg School of Medicine — spoke with The Gazette about his impression of the Hamlin episode, the response, and what it could teach about how to handle such emergencies.

“I think public awareness is fantastic,” he said. “And one of the things that will be the good that comes out of this — if there is good — is the awareness of this and the importance of (automated external defibrillators.)”

Q: What were your initial thoughts when you saw Hamlin collapse?

A: Hogrefe said his mind went to either acute head injury or a cardiac event — like “commotio cordis,” when a sudden trauma to the chest comes at such an exact moment to disrupt the heart’s electrical activity and cause cardiac arrest.

“It hits the chest when the heart is going through its electrical process,” he said of potential trauma like a hockey check, baseball hit, or football tackle. “And when it does that it just stuns the heart and stops it.”

Q: Some have wondered whether Hamlin had underlying heart or health conditions. Could something like that have played a role?

A: “I help take care of a professional sports team, and the rigor that these folks are put through by the time they get to and through college, followed by the combine in the NFL, and they do their physicals, they’re screened pretty intensively for structural heart issues,” he said. “So that wasn't the first thing that went through my mind.”

Q: What is the prognosis of someone who experiences commotio cordis?

A: Hogrefe said innumerable variables are involved in whether and how a person recovers — including how fast first responders restart your heart.

“In something like commotio cordis, an AED is critical because that's what restarts the electrical activity of your heart and jump-starts it back to working,” he said, adding CPR is helpful too in keeping blood circulating.

“Those things dictate how much damage occurs in the brain and the heart,” Hogrefe said. “Because without the oxygen flowing through your body, being circulated through the blood, your tissues in the brain and heart in particular don't get that oxygen.

“And the longer they go without it, the more difficult it is to recover.”

Q: What did you think of the Hamlin response Monday night?

A: “They responded amazingly quickly, and I’ve been on the sidelines for NFL games,” he said.

Q: What sort of responders were on hand when Hamlin went down?

A: “The NFL has interesting rules,” Hogrefe said.

It assigns a physician from the home team’s community to every visiting team, he said, and each team typically travels with their own primary care physician and orthopedic surgeon, along with sports medicine and airway specialists — for breathing issues and other needs.

“So there are countless physicians at the ready to help in case of anything — whether minor injury or a catastrophe,” he said. “And, from what I could see … they responded phenomenally.”

Q: As a team physician, have you ever faced a life-threatening emergency like the one this week?

A: Hogrefe said he’s had to run on the field to care for a player hit in the face with a 95 mph fastball. And while he hasn’t had a player in a life-threatening situation, he's dealt with fans who were — which come with unique issues, given the lack of medical history he has on them.

“I spend six to seven weeks a year in Arizona for spring training, doing all of these physicals,” he said. “So I know the players about as well as you can.”

Q: So what can the public do to be prepared if faced with a cardiac emergency?

A: First, Hogrefe said, know your setting and surroundings. Automated defibrillators now are in malls, swimming pools, gyms, public parks, and many office buildings. Given the risk a baseball could strike a player in the chest, a UI physician years ago spearheaded an initiative to get them at baseball diamonds — especially in rural Iowa, where hospitals aren’t minutes away.

If others are around, ask for help calling paramedics and finding an AED, Hogrefe said.

Because the devices give commands, users don’t need medical experience or knowledge to deploy them. Hogrefe said responders also should start CPR to get blood flowing.

“Just start pushing on the chest, 100 pumps per minute,” he said. “That whole mantra about the ‘Staying Alive’ song and following along with the rhythm of the beat, that’s the pace you should do it at.”

Q: Given heart disease is the leading cause of death in the United States — with about 697,000 Americans dying from it in 2020, or about 1 every 34 seconds, according to the U.S. Centers for Disease Control and Prevention — how are we doing with heart health knowledge and response preparation?

A: Hogrefe said he recently found himself at an intersection, looking out over a park, and noticed an AED attached to the park sign “right there, in plain sight.”

“That's good. That's fantastic,” he said. “To me, that's progress.

“It's one of those things where there's a cost associated with it. And it may never get used. But the one time it does get used, it will be worth it.”

Vanessa Miller covers higher education for The Gazette.

Comments: (319) 339-3158; vanessa.miller@thegazette.com