Precordial thump

Last updated
Precordial thump
Specialty cardiology

Precordial thump is a medical procedure used in the treatment of ventricular fibrillation or pulseless ventricular tachycardia under certain conditions. The procedure has a very low success rate, but may be used in those with witnessed, monitored onset of one of the "shockable" cardiac rhythms if a defibrillator is not immediately available. [1] [2] It should not delay cardiopulmonary resuscitation (CPR) and defibrillation, nor should it be used in those with unwitnessed out-of-hospital cardiac arrest. [1] [3]

Contents

Procedure

In a precordial thump, a provider strikes at the middle of a person's sternum with the ulnar aspect of the fist. [4] The intent is to interrupt a potentially life-threatening rhythm. The thump is thought to produce an electrical depolarization of 2 to 5 joules.[ citation needed ]

Effectiveness

Precordial thump may be effective only if used within seconds near the onset of ventricular fibrillation or pulseless ventricular tachycardia, [5] and so should be used only when the arrest is witnessed and monitored. There is no evidence that precordial thump improves recovery in unwitnessed cardiac arrest.[ citation needed ] It is also not useful against ventricular fibrillation after time has passed. [6] It has very low efficacy against ventricular arrythmia [7] (possibly even making it worse) [4] [7] and ventricular tachycardia, [2] especially compared to the alternatives of CPR and defibrillation.

While the odds of success are poor, the procedure is rapid, allowing the provider to continue with other resuscitation procedures, including CPR, medication and defibrillation as appropriate.[ citation needed ]

Adverse effects and appearance

There are concerns that the precordial thump can result in worsening of a person's heart rhythm more often than it improves it. [2]

The use of the precordial thump technique has sometimes been shown in famous movies and television, such as in The Good Doctor Season 2 episode 5 in which it is performed by Dr. Brown, and The Resident Season 1 episode 2 in which it is performed by Conrad Hawkins, usually in passing without any explanation. Untrained laypersons have been known to attempt it, and sometimes cause additional injury to the person as the blow must be carefully aimed. If applied incorrectly it may cause further injury, for instance inducing cardiac arrest by blunt trauma, or breaking the tip of the sternum, risking fatal damage to the liver or other abdominal organs.[ citation needed ]

At one time, the technique was also taught as part of standard CPR training with the requirement that it must be administered within 60 seconds of the onset of symptoms. That time restriction, combined with a number of injuries caused by improper technique,[ citation needed ] resulted in the procedure being removed from CPR training.

History

James E. Pennington and Bernard Lown 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. Richard S. Crampton and George Craddock, 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. [8]

Fist pacing

Percussion pacing or fist pacing was proposed as a method of delivering mechanical pacing to someone in cardiac arrest. There is little evidence to support its use. [9] In 1920, German physician Eduard Schott originally described percussion pacing, and a 2007 BJA article describes good benefit to this technique. [10]

Related Research Articles

<span class="mw-page-title-main">Cardiac arrest</span> Sudden stop in effective blood flow due to the failure of the heart to beat

Cardiac arrest is when the heart suddenly and unexpectedly stops beating. It is a medical emergency that, without immediate medical intervention, will result in sudden cardiac death within minutes. Cardiopulmonary resuscitation (CPR) and possibly defibrillation are needed until further treatment can be provided. Cardiac arrest results in a rapid loss of consciousness, and breathing may be abnormal or absent.

<span class="mw-page-title-main">Cardiopulmonary resuscitation</span> Emergency procedure for cardiac arrest

Cardiopulmonary resuscitation (CPR) is an emergency procedure consisting of chest compressions often combined with artificial ventilation in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person who is in cardiac arrest. It is recommended in those who are unresponsive with no breathing or abnormal breathing, for example, agonal respirations.

<span class="mw-page-title-main">Cardioversion</span> Abnormally fast heart rate or arrhythmia is converted to a normal rhythm using electricity

Cardioversion is a medical procedure by which an abnormally fast heart rate (tachycardia) or other cardiac arrhythmia is converted to a normal rhythm using electricity or drugs. Synchronized electrical cardioversion uses a therapeutic dose of electric current to the heart at a specific moment in the cardiac cycle, restoring the activity of the electrical conduction system of the heart. Pharmacologic cardioversion, also called chemical cardioversion, uses antiarrhythmia medication instead of an electrical shock.

<span class="mw-page-title-main">Advanced cardiac life support</span> Emergency medical care

Advanced cardiac life support, advanced cardiovascular life support (ACLS) refers to a set of clinical guidelines for the urgent and emergent treatment of life-threatening cardiovascular conditions that will cause or have caused cardiac arrest, using advanced medical procedures, medications, and techniques. ACLS expands on Basic Life Support (BLS) by adding recommendations on additional medication and advanced procedure use to the CPR guidelines that are fundamental and efficacious in BLS. ACLS is practiced by advanced medical providers including physicians, some nurses and paramedics; these providers are usually required to hold certifications in ACLS care.

<span class="mw-page-title-main">Defibrillation</span> Treatment for life-threatening cardiac arrhythmias

Defibrillation is a treatment for life-threatening cardiac arrhythmias, specifically ventricular fibrillation (V-Fib) and non-perfusing ventricular tachycardia (V-Tach). A defibrillator delivers a dose of electric current to the heart. Although not fully understood, this process depolarizes a large amount of the heart muscle, ending the arrhythmia. Subsequently, the body's natural pacemaker in the sinoatrial node of the heart is able to re-establish normal sinus rhythm. A heart which is in asystole (flatline) cannot be restarted by a defibrillator, but would be treated by cardiopulmonary resuscitation (CPR).

<span class="mw-page-title-main">Ventricular fibrillation</span> Rapid quivering of the ventricles of the heart

Ventricular fibrillation is an abnormal heart rhythm in which the ventricles of the heart quiver. It is due to disorganized electrical activity. Ventricular fibrillation results in cardiac arrest with loss of consciousness and no pulse. This is followed by sudden cardiac death in the absence of treatment. Ventricular fibrillation is initially found in about 10% of people with cardiac arrest.

<span class="mw-page-title-main">Asystole</span> Medical condition of the heart

Asystole is the absence of ventricular contractions in the context of a lethal heart arrhythmia. Asystole is the most serious form of cardiac arrest and is usually irreversible. Also referred to as cardiac flatline, asystole is the state of total cessation of electrical activity from the heart, which means no tissue contraction from the heart muscle and therefore no blood flow to the rest of the body.

<span class="mw-page-title-main">Automated external defibrillator</span> Portable electronic device

An automated external defibrillator (AED) is a portable electronic device that automatically diagnoses the life-threatening cardiac arrhythmias of ventricular fibrillation (VF) and pulseless ventricular tachycardia, and is able to treat them through defibrillation, the application of electricity which stops the arrhythmia, allowing the heart to re-establish an effective rhythm.

<span class="mw-page-title-main">Implantable cardioverter-defibrillator</span> Medical device

An implantable cardioverter-defibrillator (ICD) or automated implantable cardioverter defibrillator (AICD) is a device implantable inside the body, able to perform defibrillation, and depending on the type, cardioversion and pacing of the heart. The ICD is the first-line treatment and prophylactic therapy for patients at risk for sudden cardiac death due to ventricular fibrillation and ventricular tachycardia.

Basic life support (BLS) is a level of medical care which is used for patients with life-threatening illnesses or injuries until they can be given full medical care by advanced life support providers. It can be provided by trained medical personnel, such as emergency medical technicians, and by qualified bystanders.

<span class="mw-page-title-main">Ventricular tachycardia</span> Medical condition of the heart

Ventricular tachycardia is a fast heart rate arising from the lower chambers of the heart. Although a few seconds of VT may not result in permanent problems, longer periods are dangerous; and multiple episodes over a short period of time are referred to as an electrical storm. Short periods may occur without symptoms, or present with lightheadedness, palpitations, or chest pain. Ventricular tachycardia may result in ventricular fibrillation (VF) and turn into cardiac arrest. This conversion of the VT into VF is called the degeneration of the VT. It is found initially in about 7% of people in cardiac arrest.

Pulseless electrical activity (PEA) refers to cardiac arrest in which the electrocardiogram shows a heart rhythm that should produce a pulse, but does not. Pulseless electrical activity is found initially in about 55% of people in cardiac arrest.

<span class="mw-page-title-main">Advanced life support</span> Life-saving protocols

Advanced Life Support (ALS) is a set of life saving protocols and skills that extend basic life support to further support the circulation and provide an open airway and adequate ventilation (breathing).

<span class="mw-page-title-main">Commotio cordis</span> Disruption of heart rhythm that occurs as a result of a blow to the area directly over the heart

Commotio cordis is an often lethal disruption of heart rhythm that occurs as a result of a blow to the area directly over the heart at a critical time during the cycle of a heartbeat. This leads to disrupting the normal heart electrical activity, followed instantly by ventricular fibrillation, complete disorganization of the heart's pumping function, and cardiac arrest. It is not an event caused by mechanical damage to the heart muscle or surrounding organs and is not the result of heart disease.

The chain of survival refers to a series of actions that, properly executed, reduce the mortality associated with sudden cardiac arrest. Like any chain, the chain of survival is only as strong as its weakest link. The six interdependent links in the chain of survival are early recognition of sudden cardiac arrest and access to emergency medical care, early CPR, early defibrillation, early advanced cardiac life support, and physical and emotional recovery. The first three links in the chain can be performed by lay bystanders, while the second three links are designated to medical professionals. Currently, between 70 and 90% of cardiac arrest patients die before they reach the hospital. However, a cardiac arrest does not have to be lethal if bystanders can take the right steps immediately.

The history of cardiopulmonary resuscitation (CPR) can be traced as far back as the literary works of ancient Egypt. However, it was not until the 18th century that credible reports of cardiopulmonary resuscitation began to appear in the medical literature.

Pediatric advanced life support (PALS) is a course offered by the American Heart Association (AHA) for health care providers who take care of children and infants in the emergency room, critical care and intensive care units in the hospital, and out of hospital. The course teaches healthcare providers how to assess injured and sick children and recognize and treat respiratory distress/failure, shock, cardiac arrest, and arrhythmias.

<span class="mw-page-title-main">Arrhythmia</span> Group of medical conditions characterized by irregular heartbeat

Arrhythmias, also known as cardiac arrhythmias, heart arrhythmias, or dysrhythmias, are irregularities in the heartbeat, including when it is too fast or too slow. A resting heart rate that is too fast – above 100 beats per minute in adults – is called tachycardia, and a resting heart rate that is too slow – below 60 beats per minute – is called bradycardia. Some types of arrhythmias have no symptoms. Symptoms, when present, may include palpitations or feeling a pause between heartbeats. In more serious cases, there may be lightheadedness, passing out, shortness of breath or chest pain. While most cases of arrhythmia are not serious, some predispose a person to complications such as stroke or heart failure. Others may result in sudden death.

Return of spontaneous circulation (ROSC) is the resumption of a sustained heart rhythm that perfuses the body after cardiac arrest. It is commonly associated with significant respiratory effort. Signs of return of spontaneous circulation include breathing, coughing, or movement and a palpable pulse or a measurable blood pressure. Someone is considered to have sustained return of spontaneous circulation when circulation persists and cardiopulmonary resuscitation has ceased for at least 20 consecutive minutes.

<span class="mw-page-title-main">Rearrest</span>

Rearrest is a phenomenon that involves the resumption of a lethal cardiac dysrhythmia after successful return of spontaneous circulation (ROSC) has been achieved during the course of resuscitation. Survival to hospital discharge rates are as low as 7% for cardiac arrest in general and although treatable, rearrest may worsen these survival chances. Rearrest commonly occurs in the out-of-hospital setting under the treatment of health care providers.

References

  1. 1 2 Neumar, RW; Shuster, M; Callaway, CW; Gent, LM; Atkins, DL; Bhanji, F; Brooks, SC; de Caen, AR; Donnino, MW; Ferrer, JM; Kleinman, ME; Kronick, SL; Lavonas, EJ; Link, MS; Mancini, ME; Morrison, LJ; O'Connor, RE; Samson, RA; Schexnayder, SM; Singletary, EM; Sinz, EH; Travers, AH; Wyckoff, MH; Hazinski, MF (3 November 2015). "Part 1: Executive Summary: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 132 (18 Suppl 2): S315-67. doi: 10.1161/cir.0000000000000252 . PMID   26472989.
  2. 1 2 3 Nehme, Z; Andrew, E; Bernard, SA; Smith, K (Aug 27, 2013). "Treatment of monitored out-of-hospital ventricular fibrillation and pulseless ventricular tachycardia utilizing the precordial thump". Resuscitation. 84 (12): 1691–6. doi:10.1016/j.resuscitation.2013.08.011. PMID   23994203. Closed Access logo transparent.svg
  3. ↑ Cave, DM; Gazmuri, RJ; Otto, CW; Nadkarni, VM; Cheng, A; Brooks, SC; Daya, M; Sutton, RM; Branson, R; Hazinski, MF (Nov 2, 2010). "Part 7: CPR techniques and devices: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 122 (18 Suppl 3): S720-8. doi:10.1161/CIRCULATIONAHA.110.970970. PMC   3741663 . PMID   20956223. Open Access logo PLoS transparent.svg
  4. 1 2 Cotoi, S. (1981-05-01). "Precordial thump and termination of cardiac reentrant tachyarrhythmias". American Heart Journal. 101 (5): 675–677. doi:10.1016/0002-8703(81)90239-8. ISSN   0002-8703. PMID   7223609.
  5. ↑ Miller, Jeffrey; Tresch, Donald; Horwitz, Louis; Thompson, Bruce M; Aprahamian, Charles; Darin, Joseph C (1984-09-01). "The precordial thump". Annals of Emergency Medicine. Cardiopulmonary-cerebral Resuscitation: State of the Art. 13 (9, Part 2): 791–794. doi:10.1016/S0196-0644(84)80439-4. ISSN   0196-0644. PMID   6476543.
  6. ↑ Madias, Christopher; Maron, Barry J.; Alsheikh-Ali, Alawi A.; Rajab, Mohammad; Estes, N. A. Mark; Link, Mark S. (2009-10-01). "Precordial thump for cardiac arrest is effective for asystole but not for ventricular fibrillation". Heart Rhythm. 6 (10): 1495–1500. doi:10.1016/j.hrthm.2009.06.029. ISSN   1547-5271. PMID   19968931.
  7. 1 2 Haman, Ludek; Parizek, Petr; Vojacek, Jan (2009-01-01). "Precordial thump efficacy in termination of induced ventricular arrhythmias". Resuscitation. 80 (1): 14–16. doi:10.1016/j.resuscitation.2008.07.022. ISSN   0300-9572. PMID   18952350.
  8. ↑ Diehl, Digby (2000). "The Emergency Medical Services Program". To Improve Health and Health Care. Robert Wood Johnson Foundation Anthology. Vol. 2000. Robert Wood Johnson Foundation. p. 21.
  9. ↑ "Guideline 11.3: Precordial Thump & Fist Pacing" (PDF). Index of Guidelines. Australian Resuscitation Council and New Zealand Resuscitation Council. July 2011. Archived from the original on October 6, 2011. Retrieved February 15, 2014.
  10. ↑ Eich, C.; Bleckmann, A.; Schwarz, S. K. W. (2007). "Percussion pacing--an almost forgotten procedure for haemodynamically unstable bradycardias? A report of three case studies and review of the literature". British Journal of Anaesthesia. 98 (4): 429–433. doi: 10.1093/bja/aem007 . PMID   17327252.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.