Prehospital transcutaneous cardiac pacing in bradycardia and asystole

Background

Transcutaneous external cardiac pacing (TECP) provides a noninvasive, safe and rapid ventricular pacing, although there is controversy on the results observed both in hemodynamically significant bradycardia and asystole situations. The purpose of this study is to examine the success of TECP in our prehospital emergency medical team (VMER) practice, at Hospital S Francisco Xavier.

Methods and results

In this retrospective cohort study, we examined 46 patients submitted to TECP between January 2001 and November 2004 with a median age of 68.6 years (40–94 years). The mean call-to-arrival time was 7.8 min, and cardiac arrest was present at our arrival in 43.5% of the cases and bradycardia with hemodynamic repercussion in 56.5%, manifested, p.e., as syncope (61.5%), chest pain (23%) and/or dyspnoea (15.4%). In the cardiac arrest situations, classic advanced cardiac life support was always provided, resulting in electromechanical disassociation (40%), asystole (15%) and complete AV blocking (15%), present immediately before pacing. There was a survival rate in the field of 40% of these patients, of whom 75% were hemodynamically stable at hospital admission. In the bradycardia cases, complete AV blocking was the most common presenting rhythm (73%), the mean heart rate was 33 ppm, and 76.9% of patients had shock criteria. Atropine was used unsuccessfully in 61.5% of patients. The TECP resulted in hemodynamic stability in 53.8%, death in the field in 15.4% and sustained shock in 30.8%. The overall success rate of TECP in these two groups, defined as hospital admission, was 65.2%.

Conclusions

In cardiac arrest events, TECP was associated with a better survival rate on the field than our global survival rate on the field (21%). This may be due to its utilisation mainly in electromechanical disassociation and younger patients. TECP results in a correct cardiac output in much of severe bradycardia situations, allowing a stable transportation to the hospital where it may be kept or changed by other pacing approaches.