Emergency noninvasive external cardiac pacing

Joseph E. Clinton, Paul M. Zoll, Ross Zoll, Ernest Ruiz

Research output: Contribution to journalArticlepeer-review

36 Scopus citations

Abstract

Thirty-seven critical emergency department patients underwent attempts at external cardiac pacing over an 11-month period. Indications for pacing were asystole in 16, complete heart block (CHB) in 4, sinus bradycardia in 2, nodal bradycardia in 1, atrial fibrillation with bradycardia in 2, electromechanical dissociation in 1, idioventricular rhythm (IVR) in 10, and torsades de pointes in 1. Eight patients were successfully paced with improvement in their condition. Two were in asystole, two in CHB, three in sinus rhythm or atrial fibrillation with bradycardia, and one in idioventricular rhythm. Mean systolic blood pressure rise with pacing was 95 ± 50 mm Hg. Six of these patients were ultimately discharged from the hospital. One asystolic patient survived to discharge. Other survivors presented with either CHB or bradycardia. Of the 29 patients who did not respond to pacing, 5 survived to hospital discharge. Surviving nonresponder presenting rhythms were CHB in one patient, sinus or nodal bradycardia in two, IVR in one, and torsades de pointes in one. External cardiac pacemaking appears to be effective in hemodynamically significant bradycardia. It does not appear to be effective in most instances of asystole or IVR resulting from prolonged cardiac arrest. When applied to patients with a responsive myocardium, it may result in significant hemodynamic improvement and may be lifesaving.

Original languageEnglish (US)
Pages (from-to)155-162
Number of pages8
JournalJournal of Emergency Medicine
Volume2
Issue number3
DOIs
StatePublished - 1985
Externally publishedYes

Keywords

  • asystole
  • brady-asystole
  • bradycardia
  • external cardiac pacing
  • heart arrest
  • hyperkalemia
  • noninvasive
  • pacemaker-artificial
  • resuscitation

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