Application of Emergency Transcutaneous Cardiac Pacing in Hemodynamically Unstable Patients with Bradyarrhythmia in the Emergency Department

ABSTRACT

Transcutaneous cardiac pacing(TCP) is a rapid, safe, noninvasive and easily utilized form of emergency cardiac pacing, with hemodynamically similar to transvenous cardiac pacing. This paper reports the result of transcutaneous pacing in a series of patients in emergency department.32 patients with bradyanhythmia were enrolled during the study period. TCP was successful in 29(91%) patients. No evidence of electrical capture was seen in two patients in asystole and a patient with ventricular escape rhythm. Mean capture threshold was 66 mA. Transvenous pacemaker was inserted in 18(56%) of the 32 patients during transcutaneous cardiac pacing. Twenty(61%) of the 32 patients survived and eventually discharged. Ten patients(31%) were died of uncorrectable underlying disease in spite of successful ECG capture and palpable pulse by TCP. In conclusion, TCP is a reliable, noninvasive method that offers the possibility to initiate pacing within seconds and can be used by any emergency medical staff. In our opinion, it should be considered as the first choice of emergency treatment of hemodynamically unstable bradyarrhythmia.