Cardiac arrest: brady-asystolic: no clear role for external pacing

Clinical bottom line (level 2b-)

  1. Patients with an out-of-hospital cardiac arrest who received external pacing compared with no pacing were not clearly more likely to regain a pulse, be successfully resuscitated or survive to discharge.
Barthell et al: Annals of Emergency Medicine 1988; 17: 1221-1226
Expires November 2003

The study

Unblinded ?concealed quasi-randomised trial with intention-to-treat
Setting: county, USA

239 patients (aged ?, ?% male) with brady-asystolic episodes or cardiac arrest (pulseless electrical activity or asystole; or haemodynamically significant bradycardia - pulse < 60, systolic blood pressure < 90 mmHg)
Note:
  • Patients were treated using advanced cardiac life support protocols.


    • Control Group: (n = 136, 136 analysed): no intervention
    Experimental Group: (n = 103, 103 analysed): external pacer (at a rate of 80 beats/minute in pulseless patients, or capture in patients with bradycardias)

    100% followed for ? length of hospital stay
    Outcome notes:
    • resuscitated : arrival at admitting hospital with a pulse and a blood pressure

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    palpable pulse minutes 36
    (26.5%)    		 31
    (30.1%)    		 5%
    (-12% to 19%)    		 3.63%
    (-7.93% to 15.18%)    		 28
    (NNT = 7 to infinity;
    NNH = 13 to infinity)
    resuscitated minutes 28
    (20.6%)    		 22
    (21.4%)    		 1%
    (-13% to 13%)    		 0.77%
    (-9.66% to 11.2%)    		 130
    (NNT = 9 to infinity;
    NNH = 10 to infinity)
    survival to discharge days 6
    (4.41%)    		 7
    (6.8%)    		 2%
    (-4% to 8%)    		 2.38%
    (-3.58% to 8.35%)    		 42
    (NNT = 12 to infinity;
    NNH = 28 to infinity)

    Comments

    1. Patients were allocated treatment or control on alternate days.
    2. Those few patients with symptomatic bradycardia (<60/min) and hypotension (<90 mmHg systolic) may benefit from prehospital cardiac external pacing, but this requires further study.

    Citation

    1. Barthell E, Troiano P, Olson D, et al: Prehospital external cardiac pacing: a prospective controlled clinical trial. Annals of Emergency Medicine 1988; 17: 1221-1226
    Search Terms:
    Contributor: Chris Ball and Musab Hayatli, November 1999
    Reviewer: Dwight Peretz

    Clinical Question.
    Patient out-of-hospital cardiac arrest
    Intervention or Exposure external pacing
    Outcome survival to discharge