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The precordial thump.

J Miller, D Tresch, L Horwitz

    Annals of Emergency Medicine
    |September 1, 1984
    PubMed
    Summary
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    The precordial thump, recommended by the American Heart Association for cardiac arrest, is often ineffective and potentially harmful in prehospital settings for ventricular tachycardia (VT) and ventricular fibrillation (VF). Its use as an initial maneuver is not supported due to poor outcomes and potential for detrimental effects.

    Area of Science:

    • Emergency Medicine
    • Cardiology
    • Resuscitation Science

    Background:

    • The American Heart Association (AHA) guidelines recommend the precordial thump as an initial treatment for ventricular tachycardia (VT) and ventricular fibrillation (VF).
    • These recommendations are primarily based on anecdotal evidence rather than robust clinical data.
    • The precordial thump is integrated into Advanced Cardiac Life Support (ACLS) paramedic training and prehospital protocols.

    Purpose of the Study:

    • To evaluate the efficacy and safety of the precordial thump as an initial intervention for cardiac arrest patients with monitored VT or VF in a prehospital setting.
    • To determine the rate of successful conversion and adverse events associated with precordial thump application.

    Main Methods:

    • A prospective study involving 50 pulseless, non-breathing patients who received precordial thumps during ACLS resuscitation.

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  • Patients included 27 with monitored VT and 23 with monitored VF.
  • Outcomes assessed included conversion to a supraventricular rhythm, persistence of VT/VF, or conversion to more malignant arrhythmias (asystole, VF, idioventricular/electromechanical dissociation).

    • Main Results:

    • Only 11% of VT patients converted to a supraventricular rhythm; 44% remained in VT.
    • 12 of 27 VT patients (44%) were converted to more malignant rhythms, including asystole and VF.
    • 23 patients with VF received thumps with no effect; 12 were later resuscitated with standard ACLS interventions (countershock and medications).

    Conclusions:

    • The precordial thump is generally not beneficial and may be detrimental in the prehospital treatment of cardiac arrest due to VT or VF.
    • Its use as an initial maneuver in this setting is not supported by the study's findings.
    • Hypoxia and acidosis in prehospital cardiac arrest patients may contribute to the observed ineffectiveness compared to in-hospital environments.