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Immediate transthoracic pacing for cardiac asystole in an emergency department setting

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      Abstract

      This study was conducted to prospectively evaluate immediate transthoracic pacing in the emergency department for cardiac arrest patients presenting with asystole. All adult patients presenting over an 11-month period to a university teaching hospital with asystole following nontraumatic cardiopulmonary arrest received immediate transthoracic cardiac pacing. In these 48 patients, electrical capture was achieved in 23% and mechanical capture in 17%. With subsequent intraventricular administration of epinephrine and sodium bicarbonate, the percentage of responders increased to 48% and 33%, respectively. This is a statistically significant improvement in both electrical and mechanical capture rates (P < 0.001) as compared with historical controls in whom transthoracic pacemakers were employed several minutes into the resuscitation. In mechanical responders, blood pressure never exceeded 50 mm Hg and could not be sustained for over 2 mintutes. Immediate transthoracic pacing was temporarily effective at restoring myocardial electrical and mechanical activity in a substantial number of asystolic patients. Although there were no survivors, the improved electrical and mechanical capture rates with early use of transthoracic pacing is encouraging. Future studies of transthoracic pacing in the prehospital setting appear warranted.

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      References

      1. Standards and guidelines for cardiopulmonary resuscitation and emergency cardiac care.
        JAMA. 1980; 244 (suppl.): 453-509
        • Iseri LT
        • Humphrey SB
        • Siner SJ
        Prehospital bradyasystolic cardiac arrest.
        Ann Intern Med. 1978; 88: 741-745
        • Roberts JR
        • Greenberg MI
        Emergency transthoracic pacemaker.
        Ann Emerg Med. 1981; 10: 600-612
        • White JD
        Transthoracic pacing in cardiac asystole.
        Am J Emerg Med. 1983; 1: 201-203
        • Tintinalli JE
        • White BC
        Transthoracic pacing during CPR.
        Ann Emerg Med. 1981; 10: 113-116
        • Ornato JP
        • Carveth WL
        • Windle JR
        Pacemaker insertion for prehospital bradysystolic cardiac arrest.
        Ann Emerg Med. 1984; 13: 101-103
        • Myerberg RJ
        • Conde CA
        • Sung RJ
        • et al.
        Clinical, electrophysiologic, and hemodynamic profile of patients resuscitated from prehospital cardiac arrest.
        Am J Med. 1980; 68: 568-576
        • Edhog O
        • Nyquist O
        • Orsinius E
        • et al.
        Cardiac pacing through transthoracic electrode in acute myocardial infarction.
        ACTA Med Scand. 1972; 192: 145-147
        • Baksi KB
        • Hossain A
        • Chopra DS
        • et al.
        Transthoracic pacing in ventricular asystole.
        J Indian Med Assoc. 1973; 60: 134-137
        • Lessers BW
        • Julian DG
        Artificial pacing in the management of complete heart block complicating acute myocardial infarction.
        Br Med J. 1968; 2: 142-146
        • Hazard PB
        • Benton C
        • Milnor JP
        Transvenous cardiac pacing in cardiopulmonary resuscitation.
        Crit Care Med. 1981; 9: 666-668
        • Roe BB
        Intractable Stokes-Adams disease: A method of emergency management.
        Am Heart J. 1965; 69: 470-472
        • Bellet S
        • Muller OF
        • deLeon Jr., AC
        • et al.
        The use of an internal pacemaker in the treatment of cardiac arrest and slow heart rates.
        Arch Int Med. 1960; 105: 361-371
        • Roberts JR
        • Greenberg MI
        • Crisanti JW
        Successful use of emergency transthoracic pacing in bradyasystolic arrest.
        Ann Emerg Med. 1984; 13: 277-283
        • Roe BB
        • Katz HJ
        Complete heart block with intractable asystole and recurrent ventricular fibrillation with survival.
        Am J Cardiol. 1965; 15: 401-403
        • Daniel WW
        3rd edition. Biostatistics: A Foundation for Analysis in the Health Sciences. John Wiley and Sons, New York1983: 192-193
        • Brown CG
        • Hutchins GM
        • Gurley HT
        • et al.
        Injuries associated with the placement of percutaneous transthoracic pacemakers.
        Ann Emerg Med. 1985; (in press)
        • Falk RH
        • Jacobs LJ
        • Sinclair A
        • et al.
        External noninvasive cardiac pacing in out-of-hospital cardiac arrest.
        Crit Care Med. 1983; 11: 779-782