Commotio cordis can occur only upon impact within a narrow window of about 40 milliseconds in the cardiac electrical cycle, explaining why it is so rare.

[1] If cardiopulmonary resuscitation (CPR) combined with the use of an on-site automated external defibrillator is employed within three minutes of the impact, survival from commotio cordis can be as high as 58 percent.

[1][3] Due to ventricular fibrillation and resultant cessation of the cardiac output to vital organs, commotio cordis has a high fatality rate, indicated by two studies to be 72–75 percent, with survival decreasing substantially if effective resuscitation was not performed within three minutes of the impact event.

[7][8] Pronger made a full recovery after an overnight stay at Henry Ford Hospital in Detroit and would be cleared to play again four days later.

Another high-profile incident occurred on January 2, 2023, during Monday Night Football when Buffalo Bills safety Damar Hamlin experienced commotio cordis after Cincinnati Bengals wide receiver Tee Higgins's helmet struck him in the chest as he was making a tackle.

[9] Hamlin collapsed and went into cardiac arrest, and his life was saved by the Bills' training staff administering CPR and employing an automated external defibrillator (AED).

Impact energies of at least 50 joules (37 foot-pounds force) may cause cardiac arrest when applied at the right time and location of the precordium of an adult.

[1] Commotio cordis may also occur in other situations, such as in children who are physically abused, cases of torture, and frontal collisions of motor vehicles (the impact of the steering wheel against the thorax, although this has decreased substantially with the use of safety belts and air bags).

In a normal adult, the energy range involved in the precordial thump is five to ten times below that associated with commotio cordis.

[1] These factors influence the onset of commotio cordis:[1] The small window of vulnerability in the cardiac electrical cycle explains why it is a rare event.

[1] The risk of impact may be reduced by improved coaching techniques, such as teaching young batters to turn away from the ball to avoid errant pitches in baseball.

Starting in 2017, high school lacrosse players are penalized, and play is stopped immediately if they enter their own goal crease with the apparent intent of blocking shots or acting as goalkeeper.

[5] A 2017 study found that specially designed chest protectors do reduce the risk of commotio cordis, but do not offer 100 percent protection.

Boni was charged with culpable homicide, and eventually pleaded guilty to manslaughter, paying a $1,300 fine and $175,000 restitution to Schrott's family.