Effect of three emergency pacing modalities on cardiac output in cardiac arrest due to ventricular asystole

Pacing is a well recognised treatment in asystolic arrest with residual p wave activity. This can be achieved by transvenous, transthoracic, or manual external (cardiac percussion) pacing techniques. We report a case of ventricular asystole in which all three pacing modalities were applied, and demonstrate their relative effectiveness with invasive haemodynamic monitoring data. Stroke volumes were comparable with all three methods. Manual external pacing is an effective holding measure when cardiac output is compromised due to bradycardia or asystole with residual p wave activity before more definitive pacing techniques are instituted.