It’s old school. It looks cool. Its rarely done. It’s back. The precordial thump is now back in the 2010 ACLS guidelines.
2010 (New): The precordial thump should not be used for unwitnessed out-of-hospital cardiac arrest. The precordial thump may be considered for patients with witnessed, monitored, unstable VT (including pulseless VT) if a defibrillator is not immediately ready for use, but it should not delay CPR and shock delivery.
2005 (Old): No recommendation was provided previously. Why: A precordial thump has been reported to convert ventricular tachyarrhythmias in some studies. However, 2 larger case series found that the precordial thump did not result in ROSC for cases of VF. Reported complications associated with precordial thump include sternal fracture, osteomyelitis, stroke, and triggering of malignant arrhythmias in adults and children. The precordial thump should not delay initiation of CPR or defibrillation.(2010 AHA Guidline Review Summary)
The only real problem I have with the guidelines is that they don’t tell you how to do it. I would love to tell you how but I have never it done it myself. However, I have a good friend, Nurse M for this story, who is a paramedic turned nurse (this proves he is smart) who did it twice while we were working together at VHC* . So, the story as he detailed to me was the exact situation recommended in the guidelines above. The patient he was caring for was monitored and went into V-tach (I can’t remember if it was pulsed or pulseless). Nurse M witnessed the V-tach and immediately attempted a precordial thump. Without success. Thinking he hadn’t tried hard enough Nurse M then tried again. This time it worked and the patient walked home healthy and led a full life** .
The precordial thump works because all the cells in the heart can emit an electrical signal***. The precordial thump can cause an electrical discharge from those heart cells which can reset the V –fib or V-tach which is killing the patient. Its kindof the poor mans version of a defibrillator. If you really want to learn how to do the precordial thump you should read about it in the new 2010 AHA Advanced life support guidelines or join one of our ACLS classes at The Heart Center and we will teach you how to do it.
##As always, this is a blog not the New England Journal of Medicine, and therefore none of the information in it should be used for any medical purpose whatsoever. *I give these details as provenance because I HATE “this one time” stories which are never true.
**The last half of that sentence is not true at all.
***Ok, not all of them but some—we are keeping this basic.