Transvenous cardiac pacing in cardiopulmonary resuscitation

Despite widespread application of cardiac pacing to a wide variety of circumstances with minimal morbidity and remarkable success, the possible role of transvenous pacing in the acute setting of cardiac resuscitation has not been adequately evaluated. The authors report their experience with the use of transvenous pacemakers in 26 patients undergoing cardiopulmonary resuscitation (CPR). Although electrical activity was induced by pacing in nearly one-third of those whose primary disturbance was asystole, electromechanical dissociation followed and survival was not improved. Of patients in whom complete heart block or other bradycardia occurred during CPR, and in whom the rhythm disturbance was unresponsive to conventional pharmacological therapy, capture was possible in 77%, and successful resuscitation in one-third. Complications were minimal. It is concluded that transvenous cardiac pacing is beneficial in acute bradycardia developing during CPR, but no benefit in asystole was demonstrated.