Cough Cardiopulmonary Resuscitation Revisited
Testing implantable cardioverter-defibrillators requires induction of ventricular fibrillation (VF) to assess detection and termination of the arrhythmia. A 64-year-old man had spontaneous coughing on induction of VF on 3 occasions but did not cough after more sedation. The ECG and femoral artery pressure recording during these episodes are shown in the Figure. Automatic defibrillation occurred after 7 to 10 seconds. Rapid, regular coughing produced arterial blood pressure as high as 176/51 mm Hg (mean, 98), whereas VF without coughing resulted in a pulseless 27 mm Hg waveform.
Cough cardiopulmonary resuscitation (CPR) is defined as the production of arterial pulses during VF and other pulseless arrhythmias by vigorous, rhythmic coughing. It produces higher arterial pressure than conventional CPR, maintains consciousness for more than 30 seconds,1 and can convert ventricular tachycardia to sinus rhythm.2 Cineangiography during experimental canine cough CPR during VF has documented pulsatile blood flow preferentially directed to the cephalic arterial bed.3
In response to numerous Internet citations and anecdotes (>277 000), however, the American Heart Association has repeatedly stated that it “does not endorse cough CPR” and that it “…should not [their emphasis] be taught in lay-rescuer CPR training courses, because it would complicate teaching traditional CPR.”4 Similar dismissals have been issued by Mended Hearts, Inc, an organization of post-cardiac surgery patients at higher than normal risk for life-threatening arrhythmias. It is implied in these authoritative statements on the Internet that cough CPR is at best appropriate in “a monitored setting attended by medical personnel” and at worst “a hoax.” The present depiction of cough CPR is presented 3 decades after the original report4 for the following reasons:
(1) Arterial pressures were superior to any produced by conventional CPR and clearly maintained perfusion.
(2) Coughing was spontaneous and could occur outside of “a monitored setting.”
(3) Cough CPR can be effectively taught to high-risk patients and could save lives.5
The online-only Data Supplement, including a movie with audio commentary, is available with this article at http://circ.ahajournals. org/cgi/content/full/114/15/e530/DC1.
Criley JM, Niemann JT, Rosborough JP, Hausknecht M. Modifications of cardio-pulmonary resuscitation based on the cough. Circulation. 1986; 74 (suppl IV): 42–50.
American Heart Association. Cough CPR. Available at: http://www.americanheart.org/presenter.jhtml?identifier=4535. Accessed September 21, 2006.