Bradycardia: transcutaneous pacing may increase survival to discharge.

Clinical bottom line (level 2b-)

  1. Patients with symptomatic bradycardia who were given transcutaneous cardiac pacing, may be more likely to survive until hospital discharge than those not given pacing.
Hedges et al: PACE 1991; 14: 1473-1478
Expires July 2003

The study

Retrospective cohort study with ?objective ?blinded outcomes, adjusted for confounding factors, validated in an independent set of patients.
Setting: community, USA

51 patients (aged mean 73 years, 67% male) presented with or developed haemodynamically compromised bradycardia while under care of paramedics

Excluded if
  • age <17 years old
  • unwitnessed cardiovascular collapse
  • trauma
  • suspected hypothermia
  • rhythm at time of paramedic arrival was asystole, ventricular tachycardia or ventricular fibrillation


    • Control Group: (n = 24, 24 analysed): No pacing
    Experimental Group: (n = 24, 24 analysed): transcutaneous cardiac pacing-electrodes were applied to the anterior and posterior thorax. Cardiac pacing was initiated at a maximum of 200 mA at a rate of 100 beats per minute (with Trans-Pace transcutaneous cardiac pacemaker or a 'Quick-Pace' pacing device.)
    Any resultant patient discomfort noted in response to skeletal muscle contraction during pacing was treated with diazepam or morphine sulphate intravenously. In the pacing group, when an adequate haemodynamic response did not occur, i.v. therapy was given (eg. atropine, epinephrine, dopamine and bicarbonate).
    100% followed for ?
    Outcome notes:
    • presentation with palpable pulse to emergency department : Out of total number of patients.

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    presentation with palpable pulse to emergency department unknown 3
    (12.5%)    		 7
    (25.9%)    		 32%
    (4% to 52%)    		 28.4%
    (5.47% to 51.01%)    		 4
    (2 to 18)
    survival to hospital discharge unknown 0
    (0.00%)    		 4
    (14.8%)    		 15%
    (0% to 27%)    		 14.81%
    (-28.2% to -1.41%)    		 7
    (4 to 71)

    Comments

    1. The data in this trial was pooled from two trial periods.
    2. The study is too small to show any difference in presentation to the emergency department between the treatments.
    3. The paramedics who attended the patients were capable of endotracheal intubation, intravenous cannulation, application of pneumatic antishock garments, defibrillation/cardioversion and administration of cardiac medications.

    Citation

    1. Hedges JR, Ferro S, Shultz B, et al: Prehospital transcutaneous cardiac pacing for symptomatic bradycardia. PACE 1991; 14: 1473-1478
    Contributor: Clare Wotton and Musab Hayatli, September 1999
    Reviewer:

    Clinical Question.
    Patient symptomatic bradycardia
    Intervention or Exposure transcutaneous cardiac pacing
    Comparison not paced
    Outcome survival to leave hospital