Cardiac Arrhythmia Center, Division of Cardiology, Tufts Medical Center, Boston, MA 02111, USA.
Heart Rhythm. 2009 Oct;6(10):1495-500. doi: 10.1016/j.hrthm.2009.06.029. Epub 2009 Jun 25.
Precordial thump for cardiac arrest remains controversial. Although precordial blows can trigger ventricular fibrillation (VF) (i.e., commotio cordis), they paradoxically have been regarded as potential therapy for cardiac arrest. In commotio cordis, impact energy and resultant peak left ventricular (LV) pressure are important variables in VF initiation.
The purpose of this study was to assess the relationship between LV pressures generated by thumps and their effectiveness in defibrillation of VF or resuscitation of asystole after defibrillation.
After induction of VF, 10 swine each received 18 chest thumps; two sets of three thumps each with a clenched fist, a 30-mph lacrosse ball, and a 40-mph lacrosse ball. If asystole followed defibrillation, manual thumps were given to induce ventricular depolarizations until resumption of spontaneous rhythm.
During VF, generated LV pressure (mmHg) was 263 +/- 52 with manual thumps, 392 +/- 179 with 30-mph ball thumps, and 616 +/- 182 with 40-mph ball thumps (P <.001). None of the 180 thumps terminated VF. All episodes required electrical defibrillation. During asystole, generated LV pressures were greater for thumps that induced ventricular depolarizations than for those that did not (111 +/- 27 mmHg vs 73 +/- 23 mmHg, P <.001). A significant association was observed between induction of ventricular depolarizations and thump-generated LV pressures (odds ratio 2.0 per 10 mmHg rise in LV pressure, 95% confidence interval 1.8-2.1).
Despite generating high LV pressures, precordial thumps were not effective in terminating VF. Based on these data, precordial thump for VF in cardiac arrest victims cannot be recommended but for asystolic victims might be beneficial.
心前区捶击在心搏骤停中的作用仍存在争议。虽然心前区捶击可引发心室颤动（即心脏撞击症），但它也被视为心搏骤停的潜在治疗方法。在心脏撞击症中，撞击能量和由此产生的左心室（LV）峰值压力是引发心室颤动的重要变量。
本研究旨在评估捶击产生的 LV 压力与它们在除颤后终止室颤或复苏除颤后停搏的有效性之间的关系。
在诱发室颤后，每组 10 头猪各接受 18 次胸捶；两组每组 3 次，分别使用握拳、30 英里/小时曲棍球和 40 英里/小时曲棍球。如果除颤后出现停搏，则进行手动捶击以诱导心室去极化，直至恢复自主节律。
在室颤期间，手动捶击产生的 LV 压力（mmHg）为 263±52，30 英里/小时球捶击为 392±179，40 英里/小时球捶击为 616±182（P<0.001）。180 次捶击均未终止室颤。所有发作均需电除颤。在停搏期间，诱导心室去极化的捶击产生的 LV 压力大于未诱导心室去极化的捶击（111±27 mmHg 比 73±23 mmHg，P<0.001）。观察到诱导心室去极化与捶击产生的 LV 压力之间存在显著关联（LV 压力每升高 10 mmHg，发生心室去极化的可能性增加 2.0，95%置信区间为 1.8-2.1）。
尽管产生了很高的 LV 压力，但心前区捶击并不能有效地终止室颤。基于这些数据，不能推荐在心搏骤停患者的室颤中使用心前区捶击，但对于停搏患者可能有益。
