Precordial thump

Precordial thump
Intervention
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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. It should not delay cardiopulmonary resuscitation (CPR) and defibrillation, nor should it be used in those with unwitnessed or out-of-hospital cardiac arrest.

In a precordial thump, a provider strikes at the middle of a person's sternum with the ulnar aspect of the fist. The intent is to interrupt a potentially life-threatening rhythm. The thump is thought to produce an electrical depolarization of 2 to 5 joules. It is effective only if used within seconds near the onset of ventricular fibrillation or pulseless ventricular tachycardia, and so should be used only when the arrest is witnessed and monitored. There is no evidence that the precordial thump improves recovery in unwitnessed cardiac arrest.

While the odds of success are poor, the procedure is rapid, allowing the provider to continue with other resuscitation skills including CPR, medication and defibrillation as appropriate.

There are concerns that the precordial thump can result in worsening of a person's heart rhythm more often than it improves it.

The use of the precordial thump technique has sometimes been shown in movies and television, 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.

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