Transthoracic pacing in cardiac asystole

A total of 139 patients had transthoracic pacemakers introduced via a subxiphoid approach for asystole during advanced CPR in the emergency department of a large urban teaching hospital over a calendar year. Two groups were examined retrospectively, A) 34 patients who presented asystolic, and B) 99 patients who presented with ventricular fibrillation that became asystole. Age, sex, and etiologies for cardiac arrest were similar in both groups; there were no survivors. The mean duration of asystole before pacemaker insertion was 4 min (group A) to 7 min (group B). Temporary electrical capture was obtained in six patients from group B, but electrical-mechanical association could not be achieved in any of these patients.