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The following paper https://www.ncbi.nlm.nih.gov/pubmed/23994203 states that there was no effectiveness of the precordial thump in their study, if I read it correctly.

Questions:

Is this the medical consensus on this technique? What do other papers say? Does there exist a survey paper on advanced cardiac life support that perhaps has looked more into this particular technique?

Do medical schools in general teach this technique, in modern times? Do doctors tend to use this technique, in reality?

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  • What really happens to the heart during cardiac arrest and why is an AED useful? health.stackexchange.com/q/15130/3414 – Graham Chiu Feb 16 '18 at 7:40
  • If there's no aed available, it's worth a shot, but the most important thing is to reestablish perfusion – Graham Chiu Feb 16 '18 at 7:42
  • IIRC (It's been a while), I was taught PCT as a method, but was only useful as a reactive tactic in a witnessed cardiac event. – JohnP♦ Feb 16 '18 at 14:48
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    Nobody does PCTs. It hasn't been included in CPR or ACLS training since at least the early 1990s. I've participated in dozens and dozens of resuscitations both in the field and in ERs and I've never even seen one except on TV. Doing one would get you nothing but strange looks, a stern lecture from your medical director, and remedial training. – Carey Gregory♦ Feb 16 '18 at 18:27
  • @Carey Gregory your comment would be nice to be put up as an answer. – AlphaCentauri Feb 17 '18 at 1:32
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Well I have successfully used a precordial thump to cardiorevert someone but that was long before we had things such as guidelines. And a crash cart was close by.

It is thought that it should only be used when witnessing the onset of ventricular fibrillation or pulseless ventricular tachycardia but it also has the unfortunate possibility of converting that rhythm to a more lethal rhythm such as asystole. But one study showed it worked the best in asystole. Presumably because it can't get worse.

The energy delivered by a thump in the correct location is about 5 Joules compared with e.g. 300 Joules from a defibrillator.

The number needed to treat is 13-50, but the numbers needed to make the rhythm worse is 2-10. So the patient will be better off statistically if you don't employ this technique.

https://canadiem.org/the-precordial-thump-good-bad-or-ugly/

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  • What if there is no defibrillator available (and there never will be), and the rest of the conditions (such as witnessing the event) are met? Would the technique be viable then? – AlphaCentauri Mar 3 '18 at 18:43
  • Do we have telemetry in this scenario? – Graham Chiu Mar 3 '18 at 19:11
  • If you are never going to get help then yes, you can use the technique. – Graham Chiu Mar 4 '18 at 7:54

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