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June 19, 2002

Emergency Treatment for Commotio Cordis—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

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

In Reply: Dr Cheng raises the interesting and provocative question of whether the precordial thump1 could be an effective measure in resuscitating individuals in whom a chest blow induced ventricular tachycardia/fibrillation (known as commotio cordis).2,3 Cheng suggests that precordial blows may serve as a cause of sudden cardiac arrest as well as a means of mechanical defibrillation. Indeed, we are aware of 2 instances of survival from commotio cordis events that were associated with a precordial thump. Although the American Heart Association Advanced Life Support Guidelines4 do not address precordial thump, a thump remains an accepted optional practice for health professionals in a witnessed arrest, as long as it does not delay electrical defibrillation.5 Although precordial thump is not an unreasonable intervention if a defibrillator is not immediately available, in practice it appears to have low efficacy.6 Unfortunately, a prospective study testing the efficacy of the precordial thump, as suggested by Cheng, would be virtually impossible given the very low event rate and unpredictable occurrence of commotio cordis.