The role of vision in control of orientation in a back tuck somersault.

During a back tuck somersault, the angular velocity of the head is thought to surpass the visual system's ability to maintain a distinct and continuous picture of the environment. The primary objectives of this research were to determine if differences existed with regard to trunk and lower body kinematics, as well as landing balance, when gymnasts perform back tuck somersaults under different vision conditions. Ten female gymnasts (age = 11.6 +/- 2.67 years, competitive level = 8 +/- 1.15, and training time in gymnastics = 5.9 +/- 1.63 years) performed back tuck somersaults under 4 vision conditions while wearing electromagnetic sensors that allowed automatic digitizing. Although no significant differences were found between vision conditions with regard to timing, joint angles, and joint angular velocities, gymnasts were more stable at landing under conditions that allowed vision during either the entire somersault or the last half of the sumersault.

Peripheral vision and back tuck somersaults.

Although vision appears to enhance performance of somersaulting skills, few studies have investigated the source (foveal or ambient) of useful visual cues that can potentially be used by gymnasts during a somersault. Therefore, the primary objectives were to investigate the possible role of peripheral vision in the control of orientation and landing balance in a back tuck somersault. 10 female gymnasts (age = 11.6 +/- 2.7 yr., competitive level = 8 +/- 1.2, training time in gymnastics = 5.9 +/- 1.6 yr.) performed back tuck somersaults under four visual conditions (full visual field, horizontal peripheral vision limited to 100 degrees, horizonal peripheral vision limited to 60 degrees, and no vision) while wearing electromagnetic sensors that allowed automatic digitizing. Analysis yielded no statistically significant difference on any of the kinematic variables among vision conditions. Despite limiting the gymnasts' available horizontal peripheral vision, joint angles, angular velocities, and timing remained very similar. There were no statistically significant differences in landing balance between the conditions of full vision, 100 degrees peripheral vision, and 60 peripheral vision. However, gymnasts were less stable at landing when vision was absent as compared to the three other vision conditions.

Risk factors and predictors of mortality in children after ejection from motor vehicle crashes.

PURPOSE: Mortality after ejection from a motor vehicle crash (MVC) has been studied extensively in adults. The magnitude of this problem in children is relatively unknown. We retrospectively examined fatalities resulting from ejection after MVC in the state of Pennsylvania to define risk factors and predictors of mortality in children. METHODS: The records for all patients 0 to 16 years of age involved in an MVC and entered in the Pennsylvania Trauma Outcome Study between 1993 and 1997 were reviewed. We examined mortality, length of hospitalization, major injuries sustained, and impact of safety restraint devices. Significant differences were determined using chi2 test. RESULTS: There were 2,298 children involved in MVCs during this period; 189 were ejected. A total of 77% of the ejected passengers were greater than 10 years of age, 16% were 0 to 4 years of age, and 7% were 5 to 9 years of age. Overall, 88% of the ejected occupants were unrestrained. Ejection nearly tripled the overall mortality rate and significantly increased the Injury Severity Score for each age group. Infants and children 0 to 4 years of age had the highest fatality rate despite having a lower Injury Severity Score than all other age groups. Head injuries accounted for the majority of deaths in all age groups. Children older than 10 years of age had a higher incidence of associated chest, abdominal, and pelvic injuries. CONCLUSION: Our data show that most children ejected from MVCs were either unrestrained or improperly restrained. Head injuries were the most common cause of death in all age groups. Greater public awareness through educational programs targeting parents and children at risk may reduce this serious problem.

Cardiorespiratory fitness and coronary heart disease risk factors: the LDS Hospital Fitness Institute cohort.

BACKGROUND: Cardiorespiratory fitness is favorably associated with most modifiable coronary heart disease (CHD) risk factors. Findings are limited, however, by few data for women, persons with existing CHD, and low-risk populations. In the present study, we described cross-sectional associations between cardiorespiratory fitness and CHD risk factors in a large cohort of middle-aged men and women, of whom the majority were LDS Church members (Mormons), with and without existing CHD. METHODS AND RESULTS: Comprehensive health examinations were performed on 3232 men (age 45.9+/-10.8 years) and 1128 women (age 43.8+/-12.8 years) between 1975 and 1997. Maximal treadmill exercise testing was used to categorize those with (12% of the men and 10% of the women) and those without CHD into age- and sex-specific cardiorespiratory fitness quintiles. After adjustments for age, body fat, smoking status, and family history of CHD, favorable associations were observed between fitness and most CHD risk factors among men and women, regardless of CHD status. CONCLUSIONS: These data indicate that enhanced levels of cardiorespiratory fitness may confer resistance to elevations in CHD risk factors even in a low-risk sample of middle-aged men and women. Furthermore, these findings reinforce current public health recommendations that advocate increased national levels of physical activity and cardiorespiratory fitness for primary and secondary CHD prevention.

Plasma baclofen levels in children receiving continuous intrathecal baclofen infusion.

To determine the plasma baclofen concentrations of children undergoing continuous intrathecal baclofen infusion for treatment of cerebral spasticity, we assayed plasma samples from six children, 8 to 18 years of age, who were receiving intrathecal baclofen at constant rates of 77 to 400 micrograms/day. Plasma levels were at or below the limit of quantification (10 ng/mL) in all patients.

Infusion of intrathecal baclofen for generalized dystonia in cerebral palsy.

UNLABELLED: Generalized dystonia occurs in 15 to 25% of persons with cerebral palsy (CP) and responds poorly to medical and surgical treatments. OBJECT: After the authors observed a woman whose dystonic CP was dramatically improved by continuous infusion of intrathecal baclofen, they designed this pilot study to evaluate the effect of this treatment on a group of patients with dystonic CP. METHODS: The authors assessed the short-term response to intrathecal baclofen infusion in 12 patients with dystonic CP. An intrathecal catheter was inserted percutaneously and connected to an external microinfusion pump. The infusion began at a rate of 100 microg/day and was increased by 50 microg every 12 hours until the dystonia abated, adverse effects occurred, or the dose reached 900 microg/day with no improvement. Two observers, one blinded and one not blinded to the patient's treatment status, viewed videotapes made before and after the infusions and graded the dystonia in eight body regions, using a 5-point scale. Overall and regional scores were compared by using Wilcoxon signed-rank tests. CONCLUSIONS: Dystonia diminished in 10 of 12 patients whose average daily dose of intrathecal baclofen was 575 microg. Overall dystonia scores and scores for the extremities, trunk, and cervical regions were significantly better after infusion (p = 0.003). The two observers' scores were not significantly different. Programmable infusion pumps were subsequently implanted in eight patients for long-term therapy and improvement was sustained in six (p < 0.05). Intrathecal baclofen infusion is a promising treatment option for generalized dystonia associated with CP. The effects of intrathecal baclofen infusion on dystonia can be evaluated by using short-term continuous infusions.

Long-term outcome after sagittal synostosis operations.

We evaluated 27 children who had been operated on 5-10 years previously for sagittal synostosis. The mean age at operation was 0.55 years. Twenty-two children were treated by the senior author's technique, 4 by the Pi craniectomy technique and 1 by parasagittal sagittal strip craniectomies. The mean age at follow-up was 9.6 years. The cosmetic appearance of the head was graded independently by 3 examiners. Skull radiographs were graded by 2 examiners according to the appearance and presence of beaten copper markings. The cephalic index was measured. Frequent headaches were reported in 7 of 27 children and were migrainous in 3 of the 7. No child had papilledema. The children's appearance was considered to be normal or mildly abnormally by the parents in every case and by the medical observers in 25 of 27 (93%). The only 2 children with an unacceptable appearance were either operated late (3.3 years) or had a craniofacial syndrome. Skull radiographs revealed a normal or mildly abnormal appearance in 18-19 children, depending on the observer. Beaten copper markings were observed to some extent in 14 of 27 cases and did not correlate with the presence of headaches. The cranial index ranged from 62 to 78 with a mean of 70 (normal 81). Sagittal reconstructions resulted in an acceptable appearance 5-10 years postoperatively in all cases operated on at less than 1 year of age who had no syndrome. The need for long-term follow-up of children after sagittal synostosis operations cannot be determined from this sample size.

The management of brainstem gliomas in patients with neurofibromatosis 1.

The appropriate management of brainstem tumors in patients with neurofibromatosis 1 (NF1) has been problematic because the natural history of these lesions remains poorly defined. To formulate rational guidelines for the evaluation and treatment of these tumors, we reviewed the outcome of 21 patients with brainstem mass lesions followed in our NF clinic during the last 9 years. We subdivided the imaging features of these lesions into four groups: (1) diffuse enlargement of the brainstem with hypointensity on T1-weighted MR images and hyperintensity on T2-weighted images (n = 9); (2) focal enhancing masses (n = 7); (3) intrinsic tectal tumors (n = 5); and (4) focal nonenhancing areas of hypointensity on T1-weighted MR images (n = 2). Two cases exhibited two types of lesions. Twelve patients presented with, or developed, symptoms that were referable to the mass; in nine, the lesion was asymptomatic. A distinguishing feature of these tumors was their generally indolent biological behavior. With a median follow-up of 3.75 years, only 10 patients have had radiographic (n = 9) or clinical (n = 3) evidence of disease progression. In seven of these patients, the tumor subsequently stabilized in size or regressed without intervention. Only four patients, each with a focal enhancing tumor, received specific therapy for the tumor; this consisted of biopsy (n = 1), excision (n = 3), and adjuvant radiotherapy (n = 2). Each of these lesions was a low-grade glioma histologically and each remained stable in size after treatment (median follow-up = 4.25 years). Four patients with tectal tumors underwent insertion of a CSF shunt for hydrocephalus, but required no specific treatment for the tumor. None of the patients with diffuse brainstem lesions or focal areas of hypointensity required any intervention for the tumor. All 21 patients are presently alive and well. We conclude that the biological behavior of brainstem lesions in patients with NF1 differs significantly from that of lesions with a similar appearance in patients without this disorder. Although these lesions may at some time in their course exhibit clinical and radiographic progression, most do not require specific intervention. The lesions that are most likely to progress and require therapy are focal enhancing tumors; however, even lesions in this subgroup may stabilize in size or regress spontaneously without intervention. Based on these results, we recommend that intervention be limited to those lesions that exhibit rapid or unrelenting growth on serial images or that produce significant clinical deterioration.

Continuous intrathecal baclofen infusion for symptomatic generalized dystonia.

Five patients with generalized dystonia who were refractory to oral medications were treated by continuous intrathecal baclofen infusion. Dystonia was related to cerebral palsy in three patients and to Hallervorden-Spatz disease in two. Responsiveness to intrathecally administered baclofen was evaluated after bolus injections in one patient and during continuous infusions via an external micropump in four. Patients who responded to trial injections were subsequently implanted with a programmable pump for continuous infusion of baclofen. Dystonia in the three patients were cerebral palsy was substantially improved by continuous intrathecal baclofen infusion in doses of 500 to 800 micrograms/d. Benefit has persisted for > 19 months of continuous infusion. Dystonia in the two patients with Hallervorden-Spatz disease was not improved, although the screening trial was limited by side effects in one patient and by meningitis in the other. We conclude that continuous intrathecal baclofen infusion is beneficial therapy for some patients with generalized dystonia and that additional investigations are indicated.

High-grade astrocytomas in children: radiologically complete resection is associated with an excellent long-term prognosis.

High-grade astrocytomas comprise approximately 10% of intracranial tumors in children. A better prognosis in children than in adults has been reported for patients with these neoplasms, although the reasons for this survival advantage are uncertain. To determine whether any consistent factors were associated with long-term survival, we reviewed the records of 31 children with high-grade non-brain stem gliomas who were treated at our institution between 1975 and 1992. Histology was reviewed and classified according to the World Health Organization scheme, and neuroimaging studies were examined to determine the extent of resection, in both instances by individuals who were unaware of the patients' outcomes. The median overall survival for the 28 patients who survived the perioperative period was 18.5 months; 10 (36%) are currently alive, with a median follow-up of 70.5 months. The median progression-free survival (PFS) was 10.5 months; eight patients (29%) remain progression-free with a median follow-up of 78 months. The extent of resection at initial operation was associated most closely with PFS and overall survival as revealed by multivariate analysis. The 14 patients who underwent subtotal (< 90%) resection and the 7 who underwent near-total (90-99%) resection had median PFS of 5.5 and 11 months, respectively (P = 0.38), and overall survival of 10.5 and 25 months, respectively (P = 0.02). None of the seven patients who underwent gross total removal of tumor as confirmed by postoperative imaging had disease progression, with a median follow-up of 84 months (P < 0.0001). All of the tumors that underwent gross total resection were situated within the cerebral hemispheres; five of the seven patients had seizures as a presenting symptom. Both tumor location and seizures were significantly associated with outcome as determined by univariate analysis, but because of the overwhelming impact of resection extent on outcome, these factors were not independently associated with outcome as revealed by multivariate analysis. Histology was associated with outcome in the subgroup of patients with incompletely resected hemispheric tumors, in which children with anaplastic astrocytoma had a significantly better PFS than those with glioblastoma multiforme (P = 0.009). In summary, our results support the role of cytoreductive surgery in the treatment of cerebral hemispheric high-grade astrocytomas in children, which may encompass a biologically distinct group of tumors that, by virtue of their location and growth characteristics, are amenable to aggressive resection. The prognosis for children with deep-seated lesions and for those with subtotally resected hemispheric lesions is generally poor with conventional therapy.

Intracranial ependymomas of childhood: long-term outcome and prognostic factors.

A detailed outcome analysis was performed on 40 children with intracranial ependymomas treated at our institution between 1975 and 1993 to identify those factors that were predictive of overall and progression-free survival. Three patients (7.5%) who were treated in the first 5 years of the study died within 3 months of surgery and were excluded from further outcome assessments. Eight (22%) of the 37 patients who survived the perioperative period had evidence of leptomeningeal dissemination at presentation, on the basis of either imaging (three children) and/or cytological (six children) results. The 5- and 10-year progression-free survival rates among these 37 patients were 45.1 and 36.1%, respectively; overall survival rates were 57.1 and 45.0%, respectively. The site of progression was local in 17 of 19 patients with progressive disease. Three factors were found to have a significant association (P < or = 0.05) with the outcome on both univariate and multivariate analyses: 1) the extent of the resection, 2) the age of the patient at diagnosis, and 3) the duration of the symptoms before diagnosis. The 5-year progression-free and overall survivals were 8.9 and 22%, respectively, among patients who had evidence of residual disease on postoperative imaging studies, compared with 68 and 80% rates among patients with no apparent residual disease (P = 0.0001 and P < 0.0001, respectively). Patients younger than 3 years fared significantly worse than older children (5-year progression-free and overall survival rates of 12 and 22%, respectively, in the younger children versus 60 and 75% in older children (P = 0.003 and P = 0.01, respectively). In addition, patients with a duration of symptoms before diagnosis of < 1 month had a worse outcome than those with a more protracted course (5-year progression-free and overall survival rates of 33 and 33%, respectively, versus rates of 53 and 64%, respectively (P = 0.02 for both). Neither the finding of evidence for dissemination at presentation nor the detection of anaplastic histological features (e.g., dense cellularity or high numbers of mitoses) were associated with a significantly worse outcome in this series. The combination of variables that had the strongest association with both favorable and unfavorable outcomes was the combination of the age of the patient and the resection extent. Only 2 of 17 patients older than 3 years with gross total resections have died, whereas 13 of 20 children who were either younger than 3 years or had radiologically incomplete resections have died (P < 0.0001).(ABSTRACT TRUNCATED AT 400 WORDS)

A comparison of subtalar joint maximal eversion while jogging on the minitrampoline and floor.

The jogging minitrampoline is a common tool for exercise and rehabilitation that is lauded as helpful in reducing lower extremity stresses. The deformable bed of the minitrampoline may result in altered jogging mechanics of the subtalar joint, potentially leading to uncharacteristic mechanics of the lower extremity. The purpose of this study was to examine eversion of the subtalar joint in subjects jogging on the minitrampoline vs. a wooden floor surface. Subjects were instrumented with a flexible electrogoniometer (elgon) taped from the heel to the gastrocnemius along the Achilles tendon. The elgon was interfaced to a personal computer. Data were examined for the average maximal eversion values of five steps during jogging in two experiments. Results of the first experiment (N = 27) indicated significantly greater mean maximal eversion angles while jogging on the minitrampoline than on the floor. The second experiment involved 10 male and 10 female subjects jogging for 20 minutes with a counterbalanced sequence of jogging conditions, alternating between the floor and the minitrampoline. The second experiment indicated that maximal eversion angles were significantly greater on the minitrampoline than on the floor and increasing jogging time resulted in greater eversion angles and a significant interaction between jogging condition and time. Results suggest that people who should avoid valgus deviations to the lower leg should not jog on the jogging minitrampoline.

The effects of aerobic exercise after lumbar microdiscectomy.

STUDY DESIGN: This study determined whether lumbar discectomy patients could endure an aerobic exercise program sufficient to achieve a training effect, and whether any functional advantages were derived. METHODS: Trained volunteers (n = 19) were compared with untrained control subjects (n = 18) after a 12-week aerobic and rehabilitation exercise program. Subjects completed a maximal graded exercise test, a hydrostatic weighing test, and a battery of self-report inventories. RESULTS: Using a discriminant analysis, as a post hoc test, maximal oxygen consumption was found to be the factor responsible for the difference between the groups (P < 0.006). CONCLUSION: Oxygen consumption was more than three times as important as any other single variable in differentiating between the groups.

Women's gymnastics injuries. A 5-year study.

A 5-year prospective study on the time course of women's gymnastics injuries was conducted on a successful NCAA Division I team. Gymnasts recorded injuries on a computer terminal or via computer dot sheets immediately before each training session, including the injured body part, the event or activity, and the date of the injury. The definition of injury was "any damaged body part that would interfere with training." Athletes recorded injuries on the 1st day of onset and subsequently until the injury was healed. The initial onset of injury was considered a new injury. Subsequent records of the injury were considered continuing injury. Thirty-seven athletes participated through five collegiate seasons. They accounted for 5602 total training exposures with an average of 151.4 exposures per athlete. The analyses showed that gymnasts trained with an injury approximately 71% of the exposures, and a new injury could be expected from a gymnast during approximately 9% of the exposures. The largest number of injuries were of the repetitive stress syndrome type. The time series information showed that total injuries tended to increase until the middle of the competitive season, while new injuries showed prominent increases during specific training periods and during competition preparation and performance.

Prehospital transcutaneous cardiac pacing for symptomatic bradycardia.

We studied patients with symptomatic bradycardia to determine the importance of presenting hemodynamic status and prehospital transcutaneous cardiac pacing (TCP) upon patient survival. Of 51 patients with witnessed cardiovascular decompensation and initial bradycardia, 27 (53%) received TCP. There were no significant differences between the paced patients and those without TCP for mean times from collapse until cardiopulmonary resuscitation, paramedic arrival and a paceable rhythm, or from paramedic arrival until a paceable rhythm. Overall, emergency department arrival with a palpable pulse (26% in paced vs 13% in nonpaced group; P = 0.20) and survival to hospital discharge (15% in paced vs 0% nonpaced group; P = 0.07) tended to be better for the paced group. No patient without a palpable pulse on paramedic arrival survived to leave the hospital. Of patients with a palpable pulse upon paramedic arrival, survival to hospital discharge was greater for the paced group (80% in paced vs 0% in nonpaced group; P = 0.024). TCP appears to be most beneficial in those patients with bradycardia who have a palpable pulse when first seen.

Norms for the Wingate anaerobic test with comparison to another similar test.

This study was undertaken in order to develop norms for the Wingate test for physically active young men and women, and also to compare mean power measures obtained from the Wingate test with those obtained from another similar cycle ergometer test. A total of 112 males and 74 females aged 18 to 28 years comprised the subject pool. Data collected from the Wingate test included mean power for 30 s, peak power for 5 s, and a percent fatigue index. Data from the second test (Katch test) included mean power for both 30 s and 40 s. Percentile norms and descriptive statistics were generated as were multiple regression equations for prediction of mean power between the two different tests. Correlations between the two tests ranged from .66 to .87. Comparisons among data derived from this study and those reported for other athletic groups are also given.

Factors contributing to paramedic onscene time during evaluation and management of blunt trauma.

Prehospital patient management decisions are complex because the traumatized patient population is heterogeneous with respect to demographics, mechanism of injury, physiological response to injury, and time from injury to medical care. One hundred and nine blunt trauma patient evaluations by paramedics in a county-wide semirural emergency medical services (EMS) system were analyzed to determine paramedic time on the scene and the factors that might influence onscene time. Onscene time linearly correlated with a prolonged transport time. Hemodynamic and respiratory dysfunction were also associated with increased onscene time. Mean onscene time was not significantly different between high (greater than 13) and low (less than or equal to 13) trauma score (TS) groups, although patients with low TS did receive more interventions (more intravenous lines, more frequent intubation, and more frequent pneumatic antishock garment use). Similar results were found when high (greater than 10) and low (less than or equal to 10) Glasgow Coma Scale (GCS) groups were compared. The correlation of emergency department TS with initial prehospital TS and onscene time demonstrated a small improvement in TS with increasing onscene time for the patient with an initial TS greater than or equal to 13. However, patient groups with either a low TS or a low GCS score showed no significant improvement in TS with increasing onscene time. Without a strict management algorithm, paramedics use a variety of cues to guide their actions during the onscene management of blunt trauma. Future studies should address the impact of strict management algorithms on onscene time and ultimate patient outcome.

Succinylcholine-assisted intubations in prehospital care.

Although endotracheal intubation is considered the optimal technique for airway management in critically ill patients, performance of this task in the prehospital setting is at times difficult due to increased masseter muscle tone, vocal cord spasm, or patient combativeness. Use of short-acting paralyzing agents by paramedics to facilitate intubation in these situations is an uncommon practice. We report the recent experience of an emergency medical service system that has used succinylcholine (SUX) for more than ten years. We reviewed prehospital patient intubations for two years; 215 patients were intubated by paramedics without the use of SUX and 95 patients were intubated with the use of SUX. The patient group intubated with SUX was characterized by a greater percentage of women (48% vs 35%; P less than .05), a higher mean Glasgow Coma Scale score (8.6 vs 3.4), fewer intubations for cardiac arrest (3% vs 81%), and more hospital survivors (58% vs 24%; P less than .005). The groups were not different with respect to mean age or frequency of trauma. Paramedics chose to use SUX in 69% of nonarrested patients requiring intubation. SUX-assisted intubation was used most often for the indications of airway protection and respiratory distress. Review of hospital records showed no difference between the groups for frequency of either aspiration pneumonia or mechanical ventilation in patients surviving to hospital admission. No patient receiving SUX required emergency cricothyrotomy, nor was esophageal intubation noted in either group. Succinylcholine-assisted intubation was used safely and selectively by the paramedics in this EMS system to permit airway control and ventilation of patients with more difficult intubations.

Isokinetic characteristics of the knee in female, professional and university, ballet and modern dancers*.

*Study conducted as part of thesis submitted by R.D.C. in partial fulfillment of the requirements for the degree of Master of Science. The purpose of this investigation was to evaluate isokinetic characteristics of the knee in female, ballet and modern, professional and university dancers in order to evaluate possible differences among the groups. A total of 37 dancers with a mean age of 24.9 years was tested using a Cybex II dynamometer. A multiple analysis of variance (MANOVA) indicated that the ballet dancers had significantly higher H/Q ratios than modern dancers at three speeds (p < 0.024). Post hoc procedures indicated that the professional ballet dancers (PB) had significantly higher H/Q ratios than all other groups at 180 degrees /sec (p < 0.05). Also, although most of these dancers demonstrated normal peak torque/body weight values for knee extension and flexion, specific weaknesses were observed in the force decay rate of the quadriceps curves. It was concluded that these theatrical dancers were not a homogeneous group in terms of certain isokinetic characteristics.J Orthop Sports Phys Ther 1988;9(12):410-418.

Prehospital trial of emergency transcutaneous cardiac pacing.

A prospective alternate-day controlled trial of prehospital transcutaneous cardiac pacing (PACE) of hemodynamically significant bradycardia and asystole was undertaken. All patients had a Glasgow coma scale score of 12 or less. Patients in the control group (n = 101) received standard advanced cardiac life support (ACLS) care. Patients in the pacing group (n = 101) were to receive PACE in addition to standard ACLS treatment; 89 patients were actually paced. The two groups were comparable in terms of age, sex, presenting rhythm, and mean times to cardiopulmonary resuscitation (CPR) and ACLS. For the 144 patients in whom the time of arrest could be estimated, the mean times to CPR and ACLS were 5.3 +/- 4.0 and 10.9 +/- 7.1 min, respectively. For the 65 paced patients in whom the time of arrest could be estimated, the mean time from arrest to pacing was 21.8 +/- 8.8 min (range 2 to 43). Multivariate analysis of outcome variables (presentation to emergency department with a pulse, admission to the hospital, and discharge from the hospital) revealed that an initial rhythm of ventricular tachycardia or fibrillation and a short time to ACLS were correlated with a favorable outcome (p less than .05; logistic regression analysis). A short time to PACE was associated with admission to the hospital (p = .20; logistic regression analysis). The use of a stand-alone transcutaneous pacing device in the prehospital arrest setting was associated with generally long times until pacing and did not appreciably improve outcome. Use of PACE in patients demonstrating prehospital bradycardia without neurologic impairment remains to be evaluated.