Emergency transcutaneous pacing in the management of patients with bradyasystolic rhythms

Survival rates in cases of bradyasystolic cardiac arrest are uniformly low, being reported at from 0% to 3%. Recent advances in technology and microcircuitry have produced lightweight, portable external pacing devices that are less painful to the patient. In an on-going clinical trial of early transcutaneous pacing, five cases were seen in which transcutaneous pacing was begun at the onset of the patients' rhythm disturbance. All five patients survived to leave the hospital. Three of the patients were treated in the prehospital setting. Because of the rapidity with which pacing can be implemented, the ease of application and simplicity of operation, transcutaneous pacing has several advantages over the placing of transvenous pacemakers in the field or emergency department setting. In hemodynamically-compromising bradydysrhythmias unresponsive to pharmacologic intervention, the early use of transcutaneous pacing may improve survival in a group of patients who might otherwise die.