title: Precordial thump for cardiac arrest is effective for asystole but not for ventricular fibrillation.
abstract: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Cardiac Arrhythmia Center, Division of Cardiology, Tufts Medical Center, Boston, MA 02111, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Madias
authors.forename: Barry J
authors.initials: BJ
authors.lastname: Maron
authors.forename: Alawi A
authors.initials: AA
authors.lastname: Alsheikh-Ali
authors.forename: Mohammad
authors.initials: M
authors.lastname: Rajab
authors.forename: N A Mark
authors.initials: NA
authors.lastname: Estes
authors.forename: Mark S
authors.initials: MS
authors.lastname: Link
mesh_terms: D000818:Animals; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects / Q000379:methods*; D006323:Heart Arrest / Q000628:therapy*; D006336:Heart Massage / Q000009:adverse effects / Q000379:methods*; D008297:Male; D013552:Swine; D014693:Ventricular Fibrillation / Q000628:therapy*