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
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Article info
Publication history
Published online: June 29, 2009
Accepted:
June 20,
2009
Received:
April 28,
2009
Footnotes
Funding for this study was provided by the Louis J. Acompora Foundation.
Identification
Copyright
© 2009 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
