Osteopathic Manipulative Treatment for Chronic Low Back Pain

Abstract

For patients admitted to the hospital with bradyarrhythmia and palpable pulse, we agree with Galen et al that TCP can be a viable option to temporize the hemodynamics. This strategy can be successful if TCP can be performed immediately, but it is unlikely to be effective in patients with poor cardiac reserve. The patient described in our article 1 had poor cardiac reserve and deteriorated rapidly to cardiac arrest, and TCP is unlikely to have been effective. Importantly, in adult patients who develop postoperative cardiac arrest with nonshockable rhythm after open heart surgery, the current guideline of the Society of Thoracic Surgeons recommends an immediate use of epicardial pacing as a class I indication. 6 Even in the absence of epicardial pacing wires, if the postoperative arrest is likely associated with significant bradyarrhythmia, the guideline also recommends TCP as first-line treatment. 6 These recommendations emphasize that the key to successful TCP depends on the timing of initiating the treatment for patients who have been admitted to the hospital.Finally, in response to the letter from Gallen et al, we agree that TCP may have an important role for in-hospital patients with hemodynamically unstable bradyarrhythmias in the presence of palpable pulse. On the other hand, in patients with bradyarrhythmic cardiac arrest, regardless of prehospital or in-hospital arrest, more evidence is needed before TCP should be implemented.