Precordial thump: Difference between revisions
Content deleted Content added
No edit summary |
|||
| (172 intermediate revisions by 97 users not shown) | |||
| Line 1: | Line 1: | ||
{{Short description|Treatment for life-threatening cardiac dysrhythmias}} |
|||
A '''precordial thump''' is a [[medical procedure]] used in the initial response to a witnessed [[cardiac arrest]] when no [[defibrillator]] is immediately available. It can be used as a small part of the provision of [[advanced cardiac life support]] (ACLS). About 25% of patients in cardiac arrest who received a thump on the [[precordium]] regain cardiac function (Scherf and Bornemann:, 1960) |
|||
{{Infobox medical intervention |
|||
| name = Precordial thump |
|||
| image = |
|||
| caption = |
|||
| alt = |
|||
| field = Cardiology |
|||
| synonyms = |
|||
| ICD10 = |
|||
| ICD9 = |
|||
| ICD9unlinked = |
|||
| CPT = |
|||
| MeshID = |
|||
| LOINC = |
|||
| other_codes = |
|||
| MedlinePlus = |
|||
| eMedicine = |
|||
}} |
|||
'''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 rhythm]]s if a [[defibrillator]] is not immediately available.<ref name="AHA2015Part1">{{cite journal|last1=Neumar|first1=RW|last2=Shuster|first2=M|last3=Callaway|first3=CW|last4=Gent|first4=LM|last5=Atkins|first5=DL|last6=Bhanji|first6=F|last7=Brooks|first7=SC|last8=de Caen|first8=AR|last9=Donnino|first9=MW|last10=Ferrer|first10=JM|last11=Kleinman|first11=ME|date=3 November 2015|title=Part 1: Executive Summary: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.|journal=Circulation|volume=132|issue=18 Suppl 2|pages=S315-67|doi=10.1161/cir.0000000000000252|pmid=26472989|first15=ME|first22=AH|last12=Kronick|first12=SL|last13=Lavonas|first13=EJ|last14=Link|first14=MS|first24=MF|last24=Hazinski|first23=MH|last23=Wyckoff|last22=Travers|last16=Morrison|first21=EH|last21=Sinz|first20=EM|last20=Singletary|first19=SM|last19=Schexnayder|first18=RA|last18=Samson|first17=RE|last17=O'Connor|first16=LJ|last15=Mancini|doi-access=free}}</ref><ref name=":0" /> It should not delay [[cardiopulmonary resuscitation]] (CPR) and defibrillation, nor should it be used in those with unwitnessed out-of-hospital [[cardiac arrest]].<ref name="AHA2015Part1" /><ref>{{cite journal|last=Cave|first=DM |author2=Gazmuri, RJ |author3=Otto, CW |author4=Nadkarni, VM |author5=Cheng, A |author6=Brooks, SC |author7=Daya, M |author8=Sutton, RM |author9=Branson, R |author10=Hazinski, MF|title=Part 7: CPR techniques and devices: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.|journal=Circulation|date=Nov 2, 2010|volume=122|issue=18 Suppl 3|pages=S720-8|doi=10.1161/CIRCULATIONAHA.110.970970|pmid=20956223|pmc=3741663}}{{Open access}}</ref> |
|||
==Procedure== |
|||
To perform a precordial thump, a highly trained provider such as a [[paramedic]] or [[physician]] strikes a single very carefully aimed blow with the fist to the center of the patient's [[sternum]]. The intent is to possibly interrupt a heart-damaging rhythm. The precordial thump is thought to produce an electrical [[depolarization]] of 2 to 5 [[Joule]]s. However, the thump is effective only if used at the onset of [[ventricular fibrillation]] or pulseless [[ventricular tachycardia]] and so should be used only when the arrest is witnessed or monitored. There is no evidence that the precordial thump improves recovery in unwitnessed cardiac arrest. |
|||
In a precordial thump, a provider strikes at the middle of a person's [[Human sternum|sternum]] with the [[ulna]]r aspect of the fist.<ref name=":1">{{Cite journal|last=Cotoi|first=S.|date=1981-05-01|title=Precordial thump and termination of cardiac reentrant tachyarrhythmias|url=https://dx.doi.org/10.1016/0002-8703%2881%2990239-8|journal=American Heart Journal|language=en|volume=101|issue=5|pages=675–677|doi=10.1016/0002-8703(81)90239-8|pmid=7223609 |issn=0002-8703}}</ref> The intent is to interrupt a potentially life-threatening rhythm. The thump is thought to produce an electrical [[depolarization]] of 2 to 5 [[joule]]s.{{citation needed|date=March 2021}} |
|||
== Effectiveness == |
|||
A precordial thump may be given just once. While the odds of success are poor, if a precordial thump is done properly little time is lost. The provider will immediately continue with other ACLS skills, or [[CPR]] if the needed ACLS drugs and equipment (such as a defibrillator) are unavailable. |
|||
The precordial thump may only be effective if administered within seconds of the onset of [[ventricular fibrillation]] or pulseless [[ventricular tachycardia]].<ref name=":3">{{Cite journal|last1=Miller|first1=Jeffrey|last2=Tresch|first2=Donald|last3=Horwitz|first3=Louis|last4=Thompson|first4=Bruce M|last5=Aprahamian|first5=Charles|last6=Darin|first6=Joseph C|date=1984-09-01|title=The precordial thump|url=http://www.sciencedirect.com/science/article/pii/S0196064484804394|journal=Annals of Emergency Medicine|series=Cardiopulmonary-cerebral Resuscitation: State of the Art|language=en|volume=13|issue=9, Part 2|pages=791–794|doi=10.1016/S0196-0644(84)80439-4|pmid=6476543 |issn=0196-0644}}</ref> It is not helpful for treating ventricular fibrillation if too much time has passed.<ref>{{Cite journal|last1=Madias|first1=Christopher|last2=Maron|first2=Barry J.|last3=Alsheikh-Ali|first3=Alawi A.|last4=Rajab|first4=Mohammad|last5=Estes|first5=N. A. Mark|last6=Link|first6=Mark S.|date=2009-10-01|title=Precordial thump for cardiac arrest is effective for asystole but not for ventricular fibrillation|url=http://www.sciencedirect.com/science/article/pii/S1547527109006870|journal=Heart Rhythm|language=en|volume=6|issue=10|pages=1495–1500|doi=10.1016/j.hrthm.2009.06.029|pmid=19968931 |issn=1547-5271}}</ref> It also has very low effectiveness for treating [[Arrhythmia|ventricular arrhythmia]]<ref name=":2">{{Cite journal|last1=Haman|first1=Ludek|last2=Parizek|first2=Petr|last3=Vojacek|first3=Jan|date=2009-01-01|title=Precordial thump efficacy in termination of induced ventricular arrhythmias|url=http://www.sciencedirect.com/science/article/pii/S0300957208006151|journal=Resuscitation|language=en|volume=80|issue=1|pages=14–16|doi=10.1016/j.resuscitation.2008.07.022|pmid=18952350 |issn=0300-9572}}</ref> (possibly even making it worse),<ref name=":1" /><ref name=":2" /> and ventricular tachycardia,<ref name=":0" /> especially when compared to CPR and defibrillation as alternatives. |
|||
Historically, it was recommended as the initial action to take when addressing such witnessed and monitored cardiac arrests in a hospital setting.<ref name=":3" /> More recently, European guidelines recommend it should no longer be routinely used with available evidence suggesting it does not improve survival to hospital discharge.<ref>{{Cite journal |last1=Dee |first1=Ryan |last2=Smith |first2=Michael |last3=Rajendran |first3=Kausala |last4=Perkins |first4=Gavin D. |last5=Smith |first5=Christopher M. |last6=Vaillancourt |first6=Christian |last7=Avis |first7=Suzanne |last8=Brooks |first8=Steven |last9=Castren |first9=Maaret |last10=Chung |first10=Sung Phil |last11=Considine |first11=Julie |last12=Escalante |first12=Raffo |last13=Han |first13=Lim Swee |last14=Hatanaka |first14=Tetsuo |last15=Hazinski |first15=Mary Fran |display-authors=2 |date=2021 |title=The effect of alternative methods of cardiopulmonary resuscitation — Cough CPR, percussion pacing or precordial thump — on outcomes following cardiac arrest. A systematic review |url=https://www.resuscitationjournal.com/article/S0300-9572(21)00036-8/abstract |journal=Resuscitation |volume=162 |pages=73–81}}</ref> However, American guidelines continue advocating its use by healthcare professionals.<ref>{{Cite web |last1=Hutchison |first1=Julia |last2=Hu |first2=Eugene W. |date=2024 |title=Precordial Thump |url=https://www.ncbi.nlm.nih.gov/books/NBK545174/ |access-date=23 October 2024 |website=National Library of Medicine}}</ref> |
|||
The performance of a precordial thump is ''outside the scope'' of [[first aid]] and requires ''at minimum'' training in advanced cardiac life support. ACLS is performed primarily by [[physician]]s, [[paramedic]]s and [[nurse]]s with advanced training in [[emergency care]]. |
|||
==Adverse effects== |
==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.<ref name=":0">{{cite journal|last=Nehme|first=Z|author2=Andrew, E |author3=Bernard, SA |author4= Smith, K |title=Treatment of monitored out-of-hospital ventricular fibrillation and pulseless ventricular tachycardia utilizing the precordial thump.|journal=Resuscitation|date=Aug 27, 2013|pmid=23994203|doi=10.1016/j.resuscitation.2013.08.011|volume=84|issue=12|pages=1691–6}}{{Closed access}}</ref> |
|||
The use of the precordial thump technique has sometimes been shown in [[movie]]s and [[television]], usually in passing without any explanation. Untrained laypersons have been known to attempt it and sometimes cause additional injury to the |
The use of the precordial thump technique has sometimes been shown in famous [[movie]]s and [[television]], such as in [[The Good Doctor (American TV series)|''The Good Doctor'']] Season 2 episode 5 in which it is performed by Dr. Brown, and [[The Resident (TV series)|''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 [[commotio cordis|cardiac arrest by blunt trauma]], or breaking [[Xiphoid process|the tip of the sternum]], risking fatal damage to the [[liver]] or other abdominal organs.{{citation needed|date=March 2021}} |
||
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|date=May 2015}} resulted in the procedure being removed from CPR training. |
|||
==History== |
==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 [[Heart arrhythmia|arrhythmias]] could save lives.<ref>{{cite book|title = To Improve Health and Health Care|last = Diehl|first = Digby|publisher = [[Robert Wood Johnson Foundation]]|year = 2000|chapter = The Emergency Medical Services Program|chapter-url = http://www.rwjf.org/content/dam/web-assets/2000/01/the-emergency-medical-services-program|page = 21|volume = 2000|work = Robert Wood Johnson Foundation Anthology}}</ref> |
|||
== |
==Fist pacing== |
||
Percussion pacing or fist pacing was proposed as a method of delivering [[Transcutaneous pacing|mechanical pacing]] to someone in cardiac arrest. There is little evidence to support its use.<ref>{{Cite web|url = http://www.resus.org.au/policy/guidelines/section_11/precordial_thump.htm|title = Guideline 11.3: Precordial Thump & Fist Pacing|format = PDF|date = July 2011|access-date = February 15, 2014|website = Index of Guidelines|publisher = Australian Resuscitation Council and New Zealand Resuscitation Council|url-status = live|archive-url = https://web.archive.org/web/20111006225825/http://www.resus.org.au/policy/guidelines/section_11/precordial_thump.htm|archive-date = October 6, 2011}}</ref> In 1920, German physician Eduard Schott originally described percussion pacing, and a 2007 BJA article describes good benefit to this technique.<ref name=EichBleckmann2007>{{cite journal|last1=Eich|first1=C.|last2=Bleckmann|first2=A.|last3=Schwarz|first3=S. K. W.|title=Percussion pacing--an almost forgotten procedure for haemodynamically unstable bradycardias? A report of three case studies and review of the literature|journal=British Journal of Anaesthesia|volume=98|issue=4|year=2007|pages=429–433|doi=10.1093/bja/aem007|pmid=17327252|doi-access=free}}</ref> |
|||
* [http://www.jhu.edu/trayanova/research/lab/projects/each/weihui_CommotioCordis/2320.avi AVI movie 3D simulation of termination of ventricular tachycardia with a precordial thump]. |
|||
* [http://www.resus.org.au/public/guidelines/section_11/precordial_thump.htm Precordial Thump & Fist Pacing]. Australian Resuscitation Council Guideline (in PDF) |
|||
==See also== |
|||
* [[Precordial examination]] |
|||
* [[Commotio cordis]] |
|||
* [[Advanced cardiac life support]] |
|||
==References== |
==References== |
||
{{reflist}} |
|||
| ⚫ | |||
* Scherf D, and Bornemann C: Thumping of the precordium in ventricular standstill. ''American Journal of Cardiology'' 1960; 1 (1): 30-40 |
|||
* Kloeck W. et al. The Universal Advanced Life Support Algorithm. An Advisory Statement From the Advanced Life Support Working Group of the International Liaison Committee on Resuscitation . ''Circulation''. 1997;95:2180-2182. [http://circ.ahajournals.org/cgi/content/full/95/8/2180 Full paper]. |
|||
* Caldwell G, Millar G, Quinn E, Vincent R, Chamberlain DA. Simple mechanical methods for cardioversion: defence of the precordial thump and cough version. ''Br Med J'' 1985; 291:627-30. |
|||
* Miller J, Tresch D, Horwitz L, Thompson BM, Aprahamian C, Darin JC. The Precordial Thump. ''Ann Emerg Med'' 1984; 13:791-4. |
|||
[[Category:Cardiology]] |
|||
| ⚫ | |||
[[de:Präkordialer Faustschlag]] |
|||
Latest revision as of 05:11, 23 November 2024
| 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]
Procedure
[edit]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
[edit]The precordial thump may only be effective if administered within seconds of the onset of ventricular fibrillation or pulseless ventricular tachycardia.[5] It is not helpful for treating ventricular fibrillation if too much time has passed.[6] It also has very low effectiveness for treating ventricular arrhythmia[7] (possibly even making it worse),[4][7] and ventricular tachycardia,[2] especially when compared to CPR and defibrillation as alternatives.
Historically, it was recommended as the initial action to take when addressing such witnessed and monitored cardiac arrests in a hospital setting.[5] More recently, European guidelines recommend it should no longer be routinely used with available evidence suggesting it does not improve survival to hospital discharge.[8] However, American guidelines continue advocating its use by healthcare professionals.[9]
Adverse effects and appearance
[edit]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
[edit]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.[10]
Fist pacing
[edit]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.[11] In 1920, German physician Eduard Schott originally described percussion pacing, and a 2007 BJA article describes good benefit to this technique.[12]
References
[edit]- ^ a b 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.
- ^ a b c 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.
- ^ 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.
- ^ a b 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.
- ^ a b 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.
- ^ 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.
- ^ a b 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.
- ^ Dee, Ryan; Smith, Michael; et al. (2021). "The effect of alternative methods of cardiopulmonary resuscitation — Cough CPR, percussion pacing or precordial thump — on outcomes following cardiac arrest. A systematic review". Resuscitation. 162: 73–81.
- ^ Hutchison, Julia; Hu, Eugene W. (2024). "Precordial Thump". National Library of Medicine. Retrieved 23 October 2024.
- ^ Diehl, Digby (2000). "The Emergency Medical Services Program". To Improve Health and Health Care. Vol. 2000. Robert Wood Johnson Foundation. p. 21.
{{cite book}}:|work=ignored (help) - ^ "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.
- ^ 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.