Comotio Cortis

[DeepSeaDan]

Greetings Good Doctors!

Not really diving related, but I hope you'll consider this question: In my reading on Comotio Cortis I have found that this phenomena does not respond well to cpr/defibrillization; question: do you believe a "pre-cordial thump" or two might make a difference? I'd also read that this technique was coming back into favour after a lengthy
absence from pre-hospital treatment options.

Thanks!

Regards,
DSD

 

[Duke Dive Medicine]

Hi DSD,
The precordial thump came back with the 2010 American Heart Association guidelines for CPR and emergency cardiac care. It's only recommended for a witnessed ventricular arrhythmia where the patient is already on a monitor. Here's the exact wording from the journal Circulation:

"The precordial thump may be considered for termination of witnessed monitored unstable ventricular tachyarrhythmias when a defibrillator is not immediately ready for use
(Class IIb, LOE B), but should not delay CPR and shock delivery."

Class IIb means that there is conflicting evidence and/or opinion about its effectiveness, and its usefulness is not well-established. Personally, the only time I've ever used it was when I watched a patient of mine in the ICU go into ventricular fibrillation, and it popped her right back into normal sinus rhythm. Commotio cordis can't be differentiated from other causes of cardiac arrest in the field, so you're better off sticking with the AHA care guidelines by starting good, solid CPR and using an AED as soon as possible.

Best regards,
DDM