Developments in transcutaneous and transthoracic pacing during bradyasystolic arrest

Transthoracic cardiac pacing historically has been relegated to the role of the technique of last resort in treating cardiac arrest. Recent studies have shown that this technique has a high rate of successful electrical capture, but often without mechanical activity. Survival rates have been shown to be dismal when the technique is used late in cardiac arrest. Results of several recent studies of patients paced by the transcutaneous technique have suggested that electrical capture can often be rapidly obtained in asystolic or pulseless bradycardic patients. Even though electrical capture can occur late in a cardiac arrest, the development of mechanical activity with survival is rare. Survivors generally have been treated early in their arrest and have had hemodynamically ineffective bradycardias. These findings suggest that rapid initiation of transcutaneous pacing in patients with Stokes-Adams attacks, increasing heart block associated with myocardial ischemia, postdefibrillation asystole, or pulseless bradycardia may improve survival. However, victims of a prolonged cardiac arrest whose myocardium has irreversibly ceased to function mechanically are unlikely to benefit from any pacing technique.