Out-of-Hospital Transcutaneous Pacing by Emergency Medical Technicians in Patients with Asystolic Cardiac Arrest

Abstract

Transcutaneous pacing appears to offer no benefit in patients with asystolic cardiac arrest, even when it is performed as early as possible by EMTs in the field. Our data suggest that the widespread implementation of early transcutaneous pacing for out-of-hospital asystolic cardiac arrest would be ineffective.

Part 8: Adult Advanced Cardiovascular Life Support

“…[347][348][349][350] Existing evidence suggests that pacing by transcutaneous, transvenous, or transmyocardial means in cardiac arrest does not improve the likelihood of ROSC or survival outcome regardless of the timing of pacing administration (early or delayed in established asystole), location of arrest (in-hospital or out-of-hospital), or primary cardiac rhythm (asystole, PEA) targeted for treatment. Electric pacing is not recommended for routine use in cardiac arrest (Class III, LOE B).…”

ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death

“…These include pulmonary embolus, AMI, hypovolemia, hypoxia, cardiac tamponade, tension pneumothorax, preexisting acidosis, drug overdose, hypothermia, and hyperkalemia. Cardiac pacing for bradyarrhythmic or asystolic arrests is usually ineffective (345), but reversal of hypoxemia, acidosis, or electrolyte imbalances may help in some instances. Epinephrine (1.0 mg intravenously every 3 to 5 min) is commonly used in an attempt to elicit spontaneous electrical activity or increase the rate of a bradycardia.…”

Part 6: Electrical Therapies

“…Randomized controlled trials [193][194][195] and additional studies 196 -202 indicate no improvement in the rate of admission to hospital or survival to hospital discharge when paramedics or physicians attempted to provide pacing in asystolic patients in the prehospital or hospital (emergency department) setting. Pacing is not effective for asystolic cardiac arrest and may delay or interrupt the delivery of chest compressions.…”