Advertisement

Precordial thump for cardiac arrest is effective for asystole but not for ventricular fibrillation

      Background

      Precordial thump for cardiac arrest remains controversial. Although precordial blows can trigger ventricular fibrillation (VF) (i.e., commotio cordis), they paradoxically have been regarded as potential therapy for cardiac arrest. In commotio cordis, impact energy and resultant peak left ventricular (LV) pressure are important variables in VF initiation.

      Objective

      The purpose of this study was to assess the relationship between LV pressures generated by thumps and their effectiveness in defibrillation of VF or resuscitation of asystole after defibrillation.

      Methods

      After induction of VF, 10 swine each received 18 chest thumps; two sets of three thumps each with a clenched fist, a 30-mph lacrosse ball, and a 40-mph lacrosse ball. If asystole followed defibrillation, manual thumps were given to induce ventricular depolarizations until resumption of spontaneous rhythm.

      Results

      During VF, generated LV pressure (mmHg) was 263 ± 52 with manual thumps, 392 ± 179 with 30-mph ball thumps, and 616 ± 182 with 40-mph ball thumps (P <.001). None of the 180 thumps terminated VF. All episodes required electrical defibrillation. During asystole, generated LV pressures were greater for thumps that induced ventricular depolarizations than for those that did not (111 ± 27 mmHg vs 73 ± 23 mmHg, P <.001). A significant association was observed between induction of ventricular depolarizations and thump-generated LV pressures (odds ratio 2.0 per 10 mmHg rise in LV pressure, 95% confidence interval 1.8–2.1).

      Conclusion

      Despite generating high LV pressures, precordial thumps were not effective in terminating VF. Based on these data, precordial thump for VF in cardiac arrest victims cannot be recommended but for asystolic victims might be beneficial.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Heart Rhythm
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Bierfeld J.L.
        • Rodriguez-Viera V.
        • Aranda J.M.
        • Castellanos Jr, A.
        • Lazzara R.
        • Befeler B.L.
        Terminating ventricular fibrillation by chest thump.
        Angiology. 1979; 30: 703-707
        • Patros R.J.
        • Goren C.C.
        The precordial thump: an adjunct to emergency medicine.
        Heart Lung. 1983; 12: 61-64
        • Caldwell G.
        • Millar G.
        • Quinn E.
        • Vincent R.
        • Chamberlain D.A.
        Simple mechanical methods for cardioversion: defence of the precordial thump and cough version.
        Br Med J (Clin Res Ed). 1985; 291: 627-630
        • Gibbons J.J.
        • Ditto 3rd, F.F.
        Sudden asystole after spinal anesthesia treated with the “pacing thump.”.
        Anesthesiology. 1991; 75: 705
        • Michael T.A.
        • Stanford R.L.
        Precordial percussion in cardiac asystole.
        Lancet. 1963; 1: 699
        • Scherf D.
        • Bornemann C.
        Thumping of the precordium in ventricular standstill.
        Am J Cardiol. 1960; 5: 30-40
        • Deakin C.D.
        • Nolan J.P.
        European Resuscitation Council Guidelines for Resuscitation 2005.
        Resuscitation. 2005; 67: S25-S37
        • 2005 American Heart Association Guidelines for Cardiopulmonary ResuscitationEmergency Cardiovascular Care
        Part 7.2: Management of cardiac arrest.
        Circulation. 2005; 112: IV-58-IV-66
        • Efimov I.R.
        • Fedorov V.V.
        Precordial thump and commotio cordis: the yin and yang of mechanoelectric feedback in the heart.
        Heart Rhythm. 2006; 3: 187-188
        • Link M.S.
        • Wang P.J.
        • Pandian N.G.
        • et al.
        An experimental model of sudden death due to low-energy chest-wall impact (commotio cordis).
        N Engl J Med. 1998; 338: 1805-1811
        • Link M.S.
        • Ginsburg S.H.
        • Wang P.J.
        • et al.
        Commotio cordis: cardiovascular manifestations of a rare survivor.
        Chest. 1998; 114: 326-328
        • Madias C.
        • Maron B.J.
        • Alsheikh-Ali A.A.
        • Estes III, N.A.M.
        • Link M.S.
        Commotio cordis.
        Indian Pacing Electrophysiol J. 2007; 7: 235-245
        • Link M.S.
        • Maron B.J.
        • Wang P.J.
        • et al.
        Upper and lower limits of vulnerability to sudden arrhythmic death with chest-wall impact (commotio cordis).
        J Am Coll Cardiol. 2003; 41: 99-104
        • Zoll P.M.
        • Belgard A.H.
        • Weintraub M.J.
        • Frank H.A.
        External mechanical cardiac stimulation.
        N Engl J Med. 1976; 294: 1274-1275
        • Zeh E.
        • Rahner E.
        The manual extrathoracic stimulation of the heart.
        Z Kardiol. 1978; 67: 299-304
        • Amir O.
        • Schliamser J.E.
        • Nemer S.
        • Arie M.
        Ineffectiveness of precordial thump for cardioversion of malignant ventricular tachyarrhythmias.
        Pacing Clin Electrophysiol. 2007; 30: 153-156
        • Miller J.
        • Tresch D.
        • Horwitz L.
        • Thompson B.M.
        • Aprahamian C.
        • Darin J.C.
        The precordial thump.
        Ann Emerg Med. 1984; 13: 791-794
        • Pellis T.
        • Kette F.
        • Lovisa D.
        • et al.
        Utility of pre-cordial thump for treatment of out of hospital cardiac arrest: a prospective study.
        Resuscitation. 2009; 80: 17-23
        • Haman L.
        • Parizek P.
        • Vojacek J.
        Precordial thump efficacy in termination of induced ventricular arrhythmias.
        Resuscitation. 2009; 80: 14-16
        • Miller J.M.
        • Bhakta D.
        The precordial thump: convertio cordis, commotio cordis, or neither?.
        Pacing Clin Electrophysiol. 2007; 30: 151-152
        • Kohl P.
        • Nesbitt A.D.
        • Cooper P.J.
        • Lei M.
        Sudden cardiac death by commotio cordis: role of mechano-electric feedback.
        Cardiovasc Res. 2001; 50: 280-289
        • Madias C.
        • Maron B.J.
        • Weinstock J.
        • Estes III, N.A.M.
        • Link M.S.
        Commotio cordis—sudden cardiac death with chest wall impact.
        J Cardiovasc Electrophysiol. 2007; 18: 115-122
        • Li W.
        • Kohl P.
        • Trayanova N.
        Myocardial ischemia lowers precordial thump efficacy: an inquiry into mechanisms using three-dimensional simulations.
        Heart Rhythm. 2006; 3: 179-186
        • Wild J.B.
        • Grover J.D.
        The fist as an external cardiac pacemaker.
        Lancet. 1970; 2: 436-437
        • Cayla G.
        • Macia J.C.
        • Pasquie J.L.
        Images in cardiovascular medicine.
        Circulation. 2007; 115: e332
        • Koster R.W.
        Precordial thump: friend or enemy?.
        Resuscitation. 2009; 80: 2-3