Precordial thump

[ExpatMedic0]

Old School or To Cool? h34r:

I remember first learning the Precordial Thump in medic school. Over the years I was told and taught by various people that was old school and silly. Some mentioned it was no longer appropriate. However, lately I have been hearing it discussed more and more and see its even in the latest ACLS guidelines again(not sure if it ever left)

Ill get to the point. Has anyone ever preformed a Precordial Thump or Seen one preformed? What was the result? Has anyone seen any stats and or studies done on the efficiency of Precordial Thump?

 

[DesertMedic66]

I haven't personally seen one. I have had the medic do it while we were enroute to the hospital successfully.

 

[Dwindlin]

I've seen one successful one done by an ED doc in a witnessed arrest. Patient slipped into v-fib while while we were at bedside, went unresponsive, ED doc thumped him before they could get the pads on, he converted and woke up.

Having said this, I still don't think I would recommend it done routinely. I think the scenario above is the only time it is likely to do anything at all.

 

[Summit]

(2006) Myocardial ischemia lowers precordial thump efficacy: An inquiry into mechanisms using three-dimensional simulations
Weihui Li, BSa, Peter Kohl, MD, PhDb, Natalia Trayanova, PhDa http://www.sciencedirect.com/science/article/pii/S1547527105022691
Summit's Abstract: Study on rabbit ventricals showed precordial thump 60% effective in norrmoxia and 30% effective with ischemia (read protocols for details).

(2007) Ineffectiveness of Precordial Thump for Cardioversion of Malignant Ventricular Tachyarrhythmias
OFFER AMIR M.D., JORGE E. SCHLIAMSER M.D., SAMNIAH NEMER M.D., MILITIANU ARIE M.D.
http://onlinelibrary.wiley.com/doi/10.1111/j.1540-8159.2007.00643.x/abstract
Summit's Abstract: Precordial thump used as a firstline treatment for VT/VF was 1% effective (n=80). The study recommends using it only if no other means of conversion is available. (I couldn't get the full text)

Everything else I found was from the 70s and 80s.

 

[medicsb]

I tried it once and it didn't work. I believe my dad attempted it a few times and had it work once (hes an RN with 30+ years of critical care and cardiac cath lab experience).

Based on the data available... for every success story there is something like 49-99 failures.

 

[VFlutter]

I have never seen it done but if I was at the bedside and I saw the patient go into VT/VF I may try it once.

On a similar note, has any one seen or tried percussion pacing? Some Anesthesia guys swear by it.

 

[Christopher]

Has anyone seen any stats and or studies done on the efficiency of Precordial Thump?

Why strike the chest once when you can strike their chest all the way to the hospital?

Forget the precordial thump for VF/VT and start doing percussive pacing when atropine fails!

Abstract
More than 80 years after its first description by Eduard Schott, percussion (fist) pacing remains a little known procedure even though it represents an instantly available and easy to perform treatment for temporary emergency cardiac pacing in haemodynamically unstable bradycardias, including bradycardic pulseless electrical activity and complete heart block with ventricular asystole. Based on the Consensus on Science and Treatment Recommendations of the International Liaison Committee on Resuscitation, the European Resuscitation Council recently incorporated percussion pacing in its advanced life support guidelines (Nolan and colleagues, Resuscitation 67 (Suppl 1): S39-S86, 2005). Here, we briefly describe three of our own cases and present a review of the literature on percussion pacing with respect to the available evidence on its efficacy, its practical application, and clinical indications.

 

[mycrofft]

Where is it proven that proper CPR is inferior to punching people in the chest?

It is not unknown to have cases of blunt insult to the cherst CAUSE arrythmia.

Maybe if your are out on Loon Lake in Greenland or something and help is hours away.


This may be another instance of the "CPR Hero" where the patient has fallen to a transient cause of asystole, or was not truly asystolic, and would have roused anyway as long as oxygenation was maintained or the pt came-too quickly enough..

 

[Summit]

http://onlinelibrary.wiley.com/doi/10.1111/j.1540-8159.2007.00643.x/abstract[/url]
Summit's Abstract: Precordial thump used as a firstline treatment for VT/VF was 1% effective (n=80). The study recommends using it only if no other means of conversion is available. (I couldn't get the full text)

I was able to acquire the full text. Wow. I liked this line from the limitations discussion:

"it is also important to note the very short time frame from the beginning of the malignant arrhythmia to the delivery of the PT in our study. Such a short interval usually does not occur in “real-life” situations and it favors any intervention success. Therefore, we believe that the ineffectiveness of the PT in our study is so striking and beyond any technical aspects."

 

[meick77]

Not in L.A.

 

[Too Old To Work]

It seems to come and go in the ACLS protocols. It's out right now. The last time it was in it was reserved for witnessed cardiac arrest only.

I once saved a patient with a post cordial thump, but that's a story for another day.

 

[NomadicMedic]

It seems to come and go in the ACLS protocols. It's out right now. The last time it was in it was reserved for witnessed cardiac arrest only.

I once saved a patient with a post cordial thumb, but that's a story for another day.

I read that quickly and thought it said "post coital thumb". Hahah

 

[Too Old To Work]

I read that quickly and thought it said "post coital thumb". Hahah

It's supposed to be thump, not thumb. I don't know if that still makes it funny. Other than that, I'll just leave your comment on it's own.

 

[Martyn]

It's supposed to be thump, not thumb. I don't know if that still makes it funny. Other than that, I'll just leave your comment on it's own.

I'd hate to think where he stuck it :rofl:

 

[mycrofft]

Family site?:rofl:

 

[JPINFV]

I read that quickly and thought it said "post coital thumb". Hahah

Unexpected finger in the...

 

[the_negro_puppy]

It was removed from our protocols recently