Transcutaneous Pacing for Cardiac Emergencies

Abstract

Transcutaneous cardiac pacing using the Pace-Aid (Cardiac Resuscitator Corporation) was assessed in 32 emergency patients presenting with profound bradycardia or asystole who had failed to recover with advanced life support including the use of epinephrine. Pacing stimuli, pulse width 20 ms at 50, 100, or 200 mA, were delivered through two 8 cm gel-pad electrodes placed antero-posteriorly on the chest. By ECG criteria, definite electrical capture was achieved in a total of five patients and possible capture in a further 16. Of the 21 patients presenting in asystole 11 showed possible electrical capture only. No evidence of capture was seen in one third of the patients studied. Use of the Pace-Aid resulted in a palpable pulse in a total of seven patients. Four of the 11 patients with profound bradycardia survived to receive temporary transvenous pacing; two were eventually discharged. None in the asystolic group survived. Difficulties in using the Pace-Aid resulted from electrical overload by the pacing impulse that obscured the evidence for electrical capture, and intense muscle contraction that hindered reliable palpation of the arterial pulse. Transcutaneous pacing can occasionally be of value even at a late stage in the emergency treatment of profound bradycardia but is unlikely to be worthwhile in complete asystole.

Part 8: Advanced Life Support

“…Four case series (LOE 4) demonstrated that in-hospital transcutaneous pacing had slightly higher success rates for rhythm capture 401 and survival to discharge (18% to 75%) [402][403][404] compared with survival-to-discharge rates (69%) when transcutaneous pacing was given for out-ofhospital bradycardia (LOE 1). 405 A systematic review supported this survival-to-discharge rate of 15% to 70% in the prehospital setting (LOE 3).…”

Non-invasive cardiac pacing with image-guided focused ultrasound

“…The unique non-invasive method is the transcutaneous transthoracic electrical stimulation. This technique is frequently not accepted by patients because of the discomfort of the subcutaneous stimulation of the thoracic musculature as effective cardiac pacing requires high intensity pulses most of the time5.…”

Improvised Transvenous Cardiac Pacing during Operation Enduring Freedom

“…The different indications for transvenous versus transcutaneous temporary pacing are not well described in the literature. Transcutaneous pacing has advantages of being rapidly applied and does not require the same degree of technical expertise, equipment, or sterile insertion 4,7 . This makes it the temporary pacing mode of choice in the prehospital setting.…”