Kristi L. Koenig, MD, FACEP, FIFEM

Only 5% of patients with out-of-hospital cardiac arrest achieved return of spontaneous circulation after precordial thump in this Australian registry study.

According to the 2010 American Heart Association Advanced Cardiac Life Support Guidelines, “The precordial thump may be considered for patients with witnessed, monitored, unstable VT (including pulseless VT) if a defibrillator is not immediately ready for use, but it should not delay CPR and shock delivery.” To determine the effect of precordial thump, researchers in Australia retrospectively analyzed data for 434 consecutive adult (age >15 years) patients with paramedic-witnessed out-of-hospital cardiac arrest and initial rhythms of ventricular fibrillation/ventricular tachycardia over an 8-year period.

Overall, 103 patients (24%) received an initial precordial thump (thump-first group) and 325 (75%) were immediately defibrillated (shock-first group). Rhythm changes occurred in 17% of patients in the thump-first group, and included return of spontaneous circulation (ROSC) in five patients and rhythm deteriorations in ten. The rate of ROSC was significantly higher in the shock-first group (58% vs. 5%), whereas the incidence of rhythm deteriorations was similar between groups (12% vs. 10%). In the thump-first group, three of the five patients with ROSC had subsequent arrests that were treated with immediate defibrillation. Survival to hospital discharge did not differ significantly between the shock-first and thump-first groups (70% and 71%).

Citation(s):

Nehme Z et al. Treatment of monitored out-of-hospital ventricular fibrillation and pulseless ventricular tachycardia utilising the precordial thump. Resuscitation 2013 Aug 29; [e-pub ahead of print].