PRECORDIAL THUMP AS A LIFE-SAVING RESUSCITATION MEASURE IN OBESE PATIENTS DURING OUT-OF-HOSPITAL CARDIAC ARREST

Introduction: The precordial thump (PT) was until recently recognized as a life-saving measure for confirmed and monitored shockable rhythm cardiac arrest (CA) cases when a defibrillator is not immediately vailable, but cardiopulmonary resuscitation guidelines no longer mention it. Objectives: We present the PT as a life-saving measure during CA in obese patient. Case report: The emergency medical team intervened on a 69-year-old man, with, complaining of chest pain lasting >1h. He was dyspneic, pale and clammy skin. RR 18/min, SatO2 89%, HR 76 bpm, BP of 80/50 mmHg. ECG: anterior ST elevation myocardial infarction with right bundle branch block. He was allergic to aspirin. He was treated with 180mg of oral ticagrelor, a 500ml saline solution IV and 4 l/min O2 by mask and then went into CA. Before the defibrillator became available, patient was treated with three PTs, an oropharyngeal airway placement, bag valve mask ventilation with 100% oxygen and the initiation of chest compressions. When the biphasic defibrillator arrived, the monitor showed coarse ventricular fibrillation. One DC shock with 200J of energy was delivered. After the shock, the patient regained consciousness, a pulse and spontaneous breathing. The ECG monitor showed a sinus rhythm of 143 bpm, BP 80/50 mmHg, and SatO2 89%. Conclusion: Although CPR guidelines no longer mention the PT, the question remains whether it could be an initial life-saving procedure during CA in obese patients.