Noninvasive transcutaneous cardiac pacing in prehospital cardiac arrest

Eitel, David; Guzzardi, Lawrence J.; Stein, Scott; Drawbaugh, Rodney; Hess, Dean; Walton, Stacy L

doi:10.1016/s0196-0644(87)80678-9

“…So, even if the authors, are able to show a statistically significant, clear standout among the pacers tested, it remains to be seen just how well any of them perform in the prehospital setting with critically ill patients, most of whom receive no bystander CPR, and may well have transcutaneous pacemakers applied too late to be of any clinical value. Eitel, et al (1), reported electrical capture in 93% of 91 patients with prehospital pacing, but could only generate mechanical capture (evidenced by palpable pulses) in 11%. No patients survived.…”

Section: Discussionmentioning

confidence: 99%

“…have allowed the development of units which may provide high capture rates with a level of discomfort which is tolerable in the conscious patient. Transcutaneous pacing may obviate the need for emergency transvenous pacing; further, it is easily adaptable to the field setting although early application appears to be needed for success (1,2).…”

Section: Introductionmentioning

confidence: 99%

Editorial Comments

Gunderson¹,

Rottman

²

1989

Prehosp. Disaster med.

0

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“…External transcutaneous electrical stimulation of the heart has been introduced with promising results by Zoll in the mid-50s [6,7]. Over following years, the method has been refined to overcome some technical issues, and a large number of studies were published, with repeating results-good response and improved outcomes in symptomatic bradycardia cases-and very poor results in patients with asystolic cardiac arrest [8][9][10][11]. Based on these findings, external pacing is recommended in symptomatic bradycardia, but not as a part of a routine asystole management.…”

Section: Introductionmentioning

confidence: 99%

Impact of Postshock Transcutaneous Pacing on Chest Compression Quality during Resuscitation: A Simulation-Based Pilot Study

Telec

¹

,

Kłosiewicz

²

,

Zalewski

³

et al. 2021

Emergency Medicine International

1

0

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Background. Successful defibrillation is commonly followed by a transient nonperfusing state. To provide perfusion in this stagnant phase, chest compressions are recommended irrespective of arrhythmia termination. Implantable cardioverters-defibrillators (ICD) used immediately after delivery of the shock are capable of pacing the heart, and this feature is commonly activated in these devices. Potential utility of external, transcutaneous postshock pacing in patients with SCA in shockable rhythms has not been determined. This study aimed at presenting an impact of a short-term external postshock pacing (ePSP) on a quality of chest compressions (CC) without compromising them. Methods. The study was designed as a high-fidelity simulation study. Twenty triple-paramedic teams were invited. Participants were asked to take part in a 10-minute adult cardiac arrest scenario with ventricular fibrillation. In the first simulation, paramedics had to resume compressions after each shock (control group). In the second, simultaneous with compressions, one of the rescuers started transcutaneous pacing (TCP) with a current output of 200 mA and a pacer rate of 80 ppm. TCP was finished after 30 seconds (experimental group). The primary outcomes were chest compression fraction (CCF), mean depth and rate of compressions, percent of fully recoiled compressions, and percent of compressions of correct depth and their rate. Results. In both experimental and control group, CCF, mean depth, and rate were similar (84.65 ± 3.67 vs. 85.45 ± 4.95, p = 0.54 ; 55.75 ± 3.40 vs. 55.25 ± 2.73, p = 0.63 ; 122.70 ± 4.92 vs. 120.80 ± 6.00, p = 0.25 , respectively). In turn, percent of CC performed in correct depth, rate, and recoil was unsatisfactory in both groups (51.00 ± 17.40 vs. 52.60 ± 18.72, p = 0.76 ; 122.70 ± 4.92 vs. 120.80 ± 6.00, p = 0.25 , respectively). Small differences were not statistically significant. Moreover, appropriate hand-positioning was observed more frequently in the control group, and this was the only significant difference (95.60 ± 5.32 vs. 99.30 ± 1.59, p = 0.006 ). Conclusion. This difference was statistically significant ( p < 0.01 ). Introducing an ePSP does not influence relevantly the quality of CC.

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“…Transcutaneous Pacing (TCP) is a rapidly applied "non-invasive" technique that can be used successfully in the hospital, emergency department or field setting (1)(2)(3)(4)(5)(6)(7)(8)(9). Although the technique has been studied for three decades (7), it is only in the last few years that commercial units have been widely available.…”

Section: Introductionmentioning

confidence: 99%

A Comparative Study of Five Transcutaneous Pacing Devices in Unanesthetized Human Volunteers

Heller

¹

,

Peterson

²

,

Ilkahpamipour

³

et al. 1989

Prehosp. Disaster med.

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Transcutaneous Pacing (TCP) is a rapidly applied “non-invasive” technique that can be used successfully in the hospital, emergency department or field setting (1–9). Although the technique has been studied for three decades (7), it is only in the last few years that commercial units have been widely available. Improvements in pad design (particularly the development of non-metallic electrodes) and pulse characteristics (a pulse width of greater than 20 msec.) have allowed the development of units which may provide high capture rates with a level of discomfort which is tolerable in the conscious patient. Transcutaneous pacing may obviate the need for emergency transvenous pacing; further, it is easily adaptable to the field setting although early application appears to be needed for success (1,2).No study has compared the relative effectiveness of different TCP units, and there are no published data on some of the devices. The purpose of this investigation was to compare the functions of five different external pacemaker units on ten volunteers, in order to determine: 1) what percent of subjects could be captured within the limits of tolerability (the capture rate); 2) how much current was required by each unit to capture (the capture threshold); and 3) the degree of discomfort produced by each pacemaker at the capture threshold.

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Noninvasive transcutaneous cardiac pacing in prehospital cardiac arrest

Cited by 34 publications

References 19 publications

Editorial Comments

Editorial Comments

Impact of Postshock Transcutaneous Pacing on Chest Compression Quality during Resuscitation: A Simulation-Based Pilot Study

A Comparative Study of Five Transcutaneous Pacing Devices in Unanesthetized Human Volunteers

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