阿隆的 EMS 部落

胸前重擊 Precordial Thump

相信大部分的人都曾經在電視影集裡看過

當主角因為各種原因沒有了呼吸心跳，旁人急救無效時.....

這時突然有人情緒激動神來一拳往患者胸前槌下去

神奇的事情就發生了

原本瀕死的患者突然甦醒了過來 lol

這當然是編劇設計的誇大橋段～

但是這樣往胸前槌下去的動作有醫學根據嗎？

其實是有的，而且這個動作稱為：胸前重擊！

Precordial thump delivers approximately 5–10 joules of mechanical energy to the heart — far less than defibrillation.

胸前重擊可以提供約 5-10 焦耳的能量，當然，這比我們遇到 VT、VF 時所操作的去顫術所需的能量低了許多。

美國心臟協會 AHA 於 2010 年版的 ACLS 中文版 P.12 提到

要操作胸前重擊是有條件的：

胸前重擊通常建議用在親眼目擊路人倒下，摸不到脈搏，電擊器手邊又沒有的情形之下使用。

只受過基礎救命術而沒有受過ACLS的人不建議使用此方法。

以下轉貼自 張志華醫師的 急重症FB讀書會：

https://www.facebook.com/read119/posts/674339215910403

OHCA 做「胸前重擊」有 5% 成功率！

Precordial Thump Rarely of Benefit

Only 5% of patients with out-of-hospital cardiac arrest achieved return of spontaneous circulation after precordial thump in this Australian registry study.

According to the 2010 American Heart Association Advanced Cardiac Life Support Guidelines, “The precordial thump may be considered for patients with witnessed, monitored, unstable VT (including pulseless VT) if a defibrillator is not immediately ready for use, but it should not delay CPR and shock delivery.” To determine the effect of precordial thump, researchers in Australia retrospectively analyzed data for 434 consecutive adult (age >15 years) patients with paramedic-witnessed out-of-hospital cardiac arrest and initial rhythms of ventricular fibrillation/ventricular tachycardia over an 8-year period.

Overall, 103 patients (24%) received an initial precordial thump (thump-first group) and 325 (75%) were immediately defibrillated (shock-first group). Rhythm changes occurred in 17% of patients in the thump-first group, and included return of spontaneous circulation (ROSC) in five patients and rhythm deteriorations in ten. The rate of ROSC was significantly higher in the shock-first group (58% vs. 5%), whereas the incidence of rhythm deteriorations was similar between groups (12% vs. 10%). In the thump-first group, three of the five patients with ROSC had subsequent arrests that were treated with immediate defibrillation. Survival to hospital discharge did not differ significantly between the shock-first and thump-first groups (70% and 71%).

COMMENT:
Precordial thump delivers approximately 5–10 joules of mechanical energy to the heart — far less than defibrillation. This small study supports the concept that precordial thump is rarely of benefit and immediate defibrillation is more likely to result in return of spontaneous circulation. While precordial thump remains an option for a patient with a witnessed arrest when a defibrillator is not immediately available, forgoing it is reasonable.

Kristi L. Koenig, MD, FACEP, FIFEM Reviewing Nehme Z et al., Resuscitation 2013 Aug 29