Utility of pre-cordial thump for treatment of out of hospital cardiac arrest: A prospective study☆☆

Summary Background Prospective data on pre-cordial thump (PT), one of the fastest possible resuscitative manoeuvres, are scant, particularly in out-of-hospital (OOH) cardiac arrest (CA). Methods In this study, conducted in the Pordenone-province (north-east Italy), suspected OOH-CA victims were connected to a cardiac monitor and, upon confirmation of CA, subjected to a swift PT before any other resuscitatory intervention, without notable delay in other procedures. Investigation targets were: (i) effects on heart rhythm, (ii) return of spontaneous circulation (ROSC), (iii) hospital discharge, (iv) presence of adverse effects. Outcomes were additionally grouped by presenting rhythms into ventricular tachyarrhythmias (CA VF/VT ), pulseless electrical activity (CA PEA ), and asystole (CA AS ). Results Out of 144 OOH-CA cases, PT had no effect on heart rhythm in 138 patients (CA VF/VT —23/24; CA PEA —41/42; CA AS —74/78). In 112 of the 138 non-responders, ROSC was neither achieved by other interventions (CA VF/VT —13/23; CA PEA —38/41; CA AS —61/74); overall survival was 5.6% (CA VF/VT —16.7%; CA PEA —0%; CA AS —5.1%). PT caused ROSC in 3 patients with witnessed CA AS (time-to-intervention Conclusions PT can be combined with standard resuscitatory interventions without significant time-delay or apparent side effects. PT efficacy in CA VF/VT and CA PEA is lacking. However, PT may offer potential for the increasing proportion of asystolic OOH-CA, in particular when witnessed.