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(Circulation. 2006;114:e530-e531.)
© 2006 American Heart Association, Inc.

Images in Cardiovascular Medicine

Cough Cardiopulmonary Resuscitation Revisited

Marc J. Girsky, MD; John Michael Criley, MD

From Geffen School of Medicine at UCLA, Electrophysiology Services (M.G.), and Medicine and Radiological Sciences, David Geffen School of Medicine at UCLA (J.M.C.), Harbor-UCLA Medical Center, Torrance, Calif.

Correspondence to John Michael Criley, Saint John’s Cardiovascular Research Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1124 West Carson St, Torrance, CA 90502. E-mail jmcriley{at}ucla.edu

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.

View larger version (35K): [in this window] [in a new window]   Femoral arterial pressure before and during induced ventricular fibrillation during implantable defibrillator threshold testing demonstrates control blood pressure (A); rapid, regular coughing (B); slower, irregular coughing (C); and no coughing (D).

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

	Disclosures

Top Disclosures References

 
None.

	Footnotes

 
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.

	References

Top Disclosures References

 

1. Criley JM, Blaufuss JH, Kissel GL. Cough-induced cardiac compression: self-administered form of cardiopulmonary resuscitation. JAMA. 1976; 236: 1246–1250.[Abstract]
   
2. Wei JY, Green HL, Weisfeldt ML. Cough-facilitated conversion of ventricular tachycardia. Am J Cardiol. 1980; 45: 174–176.[CrossRef][Medline] [Order article via Infotrieve]
   
3. Criley JM, Niemann JT, Rosborough JP, Hausknecht M. Modifications of cardio-pulmonary resuscitation based on the cough. Circulation. 1986; 74 (suppl IV): 42–50.
   
4. American Heart Association. Cough CPR. Available at: http://www.americanheart.org/presenter.jhtml?identifier=4535. Accessed September 21, 2006.
   
5. Petelenz T, Iwinski J, Chelbowczyx J, Czyx Z, Flak Z, Fiutowski L, Zaorski K, Petelenz T, Zeman S. Self-administered cough cardiopulmonary resuscitation (c-CPR) in patients threatened by MAS events of cardiovascular origin. Wiad Lek. 1998; 51: 326–336.[Medline] [Order article via Infotrieve]
   

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				J. M. Criley and M. J. Girsky Response to Letter Regarding Article, "Cough Cardiopulmonary Resuscitation Revisited" Circulation, May 15, 2007; 115(19): e461 - e461. [Full Text] [PDF]

This Article Full Text (PDF) Data Supplement Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Girsky, M. J. Articles by Criley, J. M. Search for Related Content PubMed PubMed Citation Articles by Girsky, M. J. Articles by Criley, J. M. Related Collections Health policy and outcome research CPR and emergency cardiac care Angiography Related Article