Procedure
To perform a precordial thump, a highly trained provider strikes a single, very carefully aimed blow with the fist to a specific place on the patient's sternum. The intent is to interrupt a potentially life-threatening rhythm. The thump is thought to produce an electrical depolarization of 2 to 5 joules. However, it is effective only if used near the onset of ventricular fibrillation or pulseless ventricular tachycardia, and so should be used only when the arrest is witnessed or monitored. About 25% of patients in cardiac arrest who received a thump on the precordium regained cardiac function (Scherf and Bornemann, 1960); there is no evidence that the precordial thump improves recovery in unwitnessed cardiac arrest.
A precordial thump may be attempted only once during the onset of cardiac arrest. While the odds of success are poor, if the procedure is performed properly then little time is lost. The provider will immediately continue with other ACLS skills, including CPR, ACLS drugs, and defibrillation, as appropriate.
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