Precordial thump
The precordial thump is a medical procedure that used to be used by healthcare professionals in the initial response to a witnessed cardiac arrest when no defibrillator is immediately available. The procedure is outside the scope of first-aid treatment for cardiac arrest, and requires, at minimum, training in advanced cardiac life support (ACLS). ACLS does not currently recommend that healthcare professionals use this technique.
To perform a precordial thump, a highly trained provider strikes a single, very carefully-aimed blow with the fist to the center of the patient's sternum. The intent is to interrupt a potentially-life threatening rhythm, should one be developing. The thump is thought to produce an electrical depolarization of 2 to 5 joules. However, it is effective only if used at the onset of ventricular fibrillation or pulseless ventricular tachycardia, and so should be used only when the arrest is witnessed or monitored. About 25% of patients in cardiac arrest who received a thump on the precordium regained cardiac function (Scherf and Bornemann, 1960); there is no evidence that the precordial thump improves recovery in unwitnessed cardiac arrest.
A precordial thump may be attempted only once during the onset of cardiac arrest. While the odds of success are poor, if the procedure is performed properly then little time is lost. The provider will immediately continue with other ACLS skills, or CPR if the needed ACLS drugs and equipment (such as a defibrillator) are not immediately available.
Adverse effects
The use of the precordial thump technique has sometimes been shown in movies and television, usually in passing without any explanation. Untrained laypersons have been known to attempt it, and sometimes cause additional injury to the patient as the blow must be carefully aimed. Commotio cordis, cardiac arrest caused by blunt trauma to the heart, may ensue if a precordial thump is applied with a wrong timing.
At one time, the technique was also taught as part of standard CPR training with the requirement that it must be administred within 60 seconds of the onset of symptoms. That time restriction combined with a number of events when the thump resulted in the tip of the sternum being broken off because of improper placement, resulted in the procedure being removed from CPR training.
History
Drs. Jack Pennington and Bernard Lown's cardiology group at Harvard University are credited with formalizing this technique in the medical literature. They published their report in the New England Journal of Medicine in the early 1970s. Drs. Richard S. Crampton and George Craddock, cardiologists at the University of Virginia helped to promote the paramedic use of chest thump through a curious accident. In 1970, the Charlottesville-Albemarle Rescue Squad (VA) was transporting a patient with an unstable cardiac rhythm in what was then called a Mobile Coronary Care Unit. When the vehicle inadvertently hit a speed bump in a shopping center parking lot, the patient's normal heart rhythm was restored. Further research confirmed that chest thumping patients with life-threatening arrhythmias could save lives [1].
External links
- Precordial Thump & Fist Pacing. Australian Resuscitation Council Guideline (in PDF)
- VIDEO of Precordial thump
See also
References
- Scherf D, and Bornemann C: Thumping of the precordium in ventricular standstill. American Journal of Cardiology 1960; 1 (1): 30-40
- Kloeck W. et al. The Universal Advanced Life Support Algorithm. An Advisory Statement From the Advanced Life Support Working Group of the International Liaison Committee on Resuscitation . Circulation. 1997;95:2180-2182. Full paper.
- Caldwell G, Millar G, Quinn E, Vincent R, Chamberlain DA. Simple mechanical methods for cardioversion: defence of the precordial thump and cough version. Br Med J 1985; 291:627-30.
- Miller J, Tresch D, Horwitz L, Thompson BM, Aprahamian C, Darin JC. The Precordial Thump. Ann Emerg Med 1984; 13:791-4.de:Präkordialer Faustschlag
