External cardiac pacing for out-of-hospital bradyasystolic arrest

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      Cardiac pacing has been used successfully in patients with asystole or bradycardia compromising hemodynamics when it was applied soon after the onset of the event. An external cardiac pacemaker was used as part of initial resuscitative efforts for patients in primary, out-of-hospital, cardiac arrest who arrived in the emergency department in asystole, agonal rhythm, pulseless idioventricular rhythm, or bradycardia with hemodynamic compromise. A pulse was successfully generated in only one of twelve patients. That patient developed complete atrioventricular dissociation while in the emergency department. The nonresponding patients were in asystole or pulseless idioventricular rhythm when the pacemaker was applied. Pacing was initiated 1–13 minutes (mean 7 minutes) after arrival in the emergency department, but 27–90 minutes (mean 59 minutes) after arrest. The interval between arrest and application of the pacemaker was prolonged because of long periods for ambulance response, field resuscitation, and transport. It is concluded that the external cardiac pacemaker is a useful instrument for the treatment of bradyarrhythmias. While it may also be useful in the first few minutes after development of asystole, pulseless idioventricular rhythm, or agonal rhythm, it is of no benefit if applied long after the event.


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        • Zoll PM
        Resuscitation of the heart in ventricular standstill by external electrical stimulation.
        New Engl J Med. 1952; 247: 768-771
        • Zoll PM
        • Linenthal AJ
        • Norman LR
        Treatment of Stokes-Adams disease by external electric stimulation of the heart.
        Circulation. 1954; 9: 482-493
        • Falk RH
        • Zoll PM
        • Zoll RH
        Safety and efficacy of noninvasive cardiac pacing.
        New Engl J Med. 1983; 309: 1166-1168
        • Tintinalli JE
        • White BC
        Transthoracic pacing during CPR.
        Ann Emerg Med. 1981; 10: 113-116
        • Hazard PB
        • Benton C
        • Milnor JP
        Transvenous cardiac pacing in cardiopulmonary resuscitation.
        Crit Care Med. 1991; 9: 666-668
        • Ornato JP
        • Carveth WL
        • Windle JR
        Pacemaker insertion for prehospital bradyasystolic cardiac arrest.
        Ann Emerg Med. 1984; 13: 101-103
        • Dalsey WC
        • Syverud SA
        • Hedges JR
        Emergency department use of transcutaneous pacing for cardiac arrests.
        Crit Care Med. 1984; 12: 301
        • Liberthson RR
        • Nagel EL
        • Hirschman JC
        • et al.
        Pathophysiologic observations in prehospital ventricular fibrillation and sudden cardiac death.
        Circulation. 1974; 49: 790-798
        • Iseri LT
        • Humphrey SB
        • Siner EJ
        Prehospital brady-asystolic cardiac arrest.
        Ann Intern Med. 1978; 88: 741-745
        • Panidis IP
        • Morganroth J
        Sudden death in hospitalized patients: cardiac rhythm disturbances detected by ambulatory electrocardiographic monitoring.
        J Amer Coll Cardiol. 1983; 2: 798-805
        • Zoll PM
        • Linenthal AJ
        • Norman LR
        • et al.
        Use of external electric pacemaker in cardiac arrest.
        JAMA. 1955; 159: 1428-1431
        • White JM
        • Nowak RM
        • Martin GB
        • et al.
        Immediate emergency department external cardiac pacing for prehospital bradyasystolic arrest.
        Ann Emerg Med. 1984; 13: 387
        • White JD
        • Brown CG
        Immediate transthoracic pacing for cardiac asystole in an emergency department setting.
        Am J Emerg Med. 1985; 3: 125-128
        • Falk RH
        • Jacobs L
        • Sinclair A
        • et al.
        External noninvasive cardiac pacing in out-of-hospital cardiac arres.
        Crit Care Med. 1983; 11: 779-782
        • Paris PM
        • Stewart RD
        • Kaplan R
        • et al.
        Prehospital use of transcutaneous cardiac pacing.
        Ann Emerg Med. 1984; 13: 387-388
        • Coxon MK
        • Dinerman N
        Developments in external cardiac pacing (abstract).
        Am J Emerg Med. 1984; 2: 349