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Letters
June 19, 2002

Emergency Treatment for Commotio Cordis

Author Affiliations
 

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

JAMA. 2002;287(23):3080. doi:10.1001/jama.287.23.3077

To the Editor: Dr Maron and colleagues1 reported that ventricular tachycardia/fibrillation was identified in 36 of 82 cases of commotio cordis and that most were successfully resuscitated by an external defibrillator.

Time is of the essence in treating this lethal tachyarrhythmia, and external defibrillators are often unavailable. Thumpversion,2 or a manual thump to the precordium, has been shown to be effective in terminating both ventricular tachycardia and ventricular fibrillation.3 It might seem to be a paradox to treat commotio cordis, which is caused by a chest blow, by a second precordial thump. Caldwell et al,4 however, reported that thumpversion was efficacious in a prospective study of 5000 medical-surgical patients. Therefore, a chest blow is apparently a double-edged sword: it can cause sudden ventricular arrhythmias but also terminate them.

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