The effect of alternative methods of cardiopulmonary resuscitation — Cough CPR, percussion pacing or precordial thump — on outcomes following cardiac arrest. A systematic review

Joint British Societies’ guideline on management of cardiac arrest in the cardiac catheter laboratory

“…ILCOR produced a worksheet on this subject in 2021. 21 This documents that precordial thump is only effective in 2% of attempts and, in fact, rhythm deterioration is twice as common as successful cardioversion. Thus, our protocol does not recommend a precordial thump.…”

“…ILCOR performed a systematic review in 2021. 21 Their conclusion was as follows: 'We suggest cough CPR may only be considered as a temporising measure in an exceptional circumstance in a witnessed, monitored, in-hospital setting (such as a cardiac catheterisation laboratory) if a non-perfusing rhythm is recognised promptly before loss of consciousness (weak recommendation, very-low-certainty evidence)'.…”

“…ILCOR performed a systematic review on this subject in 2021. 21 The total number of cases reported in the literature is around 170 patients and in the largest series of 100 patients, 69 of these maintained consciousness and 90 had percussion pacing as an alternative to CPR. 26 In a study performed in 1978 27 19 healthy volunteers and 31 patients with paused pacing had a right heart catheter and the authors found reliable electrical impulses could be reproduced for up to 6 min when the left lower sternum was struck with the clenched fist from about 20-30 cm height, by causing the right ventricular pressure to rise by around 20 mm Hg with this action.…”

CPR-related cognitive activity, consciousness, awareness and recall, and its management: A scoping review

“…For the purpose of the scoping review, we also included review articles, case reports and case series, grey literature and unpublished studies (e.g., conference abstracts, trial protocols). Articles based around the Lazarus phenomenon 6 and cough CPR 7 as well as narrative articles referring to near-death experiences and consciousness were excluded. Children and animal studies were excluded.…”

Advanced Life Support Update

“…Resuscitation should be started with chest compressions first, unless the person is attached to a defibrillator at the time of a witnessed cardiac arrest, in which case up to three successive shocks may be delivered. Cough CPR, fist pacing, and precordial thump are generally ineffective and their use should not delay definitive treatment with CPR and defibrillation [16].…”