Annals of emergency medicine
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To test the efficacy of transcutaneous pacing in prehospital bradyasystolic arrest, we applied an external transcutaneous pacing device to patients with asystole, pulseless idioventricular rhythms (PIVR), and pulseless bradycardias. Pacemaker units were carried by emergency medical services (EMS) physicians and specially trained EMS personnel. Patients were followed to determine hospital course and outcome. ⋯ The average time to application of the pacing device was 29 minutes after loss of pulse. Our data strongly suggest that delayed use of the transcutaneous pacing device does not improve the dismal survival rates of patients who suffer bradyasystolic cardiac arrest. Further studies should be directed toward investigating survival rates in patients paced immediately after the onset of cardiac arrest.
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Nine dogs were hemorrhaged to approximately 40% of their blood volume and then were resuscitated with a crystalloid solution (Normosol) at various flow rates. Three study groups with three dogs in each group were resuscitated at 15 mL/min/kg (Group 1), 6 mL/min/kg (Group 2), and 4 mL/min/kg (Group 3). Central venous pressure (CVP), pulmonary artery wedge pressure (PAWP), mean arterial pressure, and cardiac output (CO) were monitored during the hemorrhage and the resuscitation from shock. ⋯ Group 3 animals had a rise in CO to 5 L/min; CVP and PAWP rose to 4.5 mm Hg and 6.8 mm Hg, respectively. In this experimental shock study, infusion of crystalloids at 6 mL/min/kg appeared to result in an improved physiologic response, although no statistical difference was demonstrated. Further studies are necessary to demonstrate the optimum flow rate for resuscitation of hypovolemic shock using crystalloids.
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Approximately 25% of patients in prehospital cardiac arrest present in bradyasystolic rhythms, and their long-term prognosis is very poor. Our study was undertaken to determine the utility of immediate emergency department (ED) external cardiac pacing in this situation. Twenty patients presenting with bradyasystolic prehospital cardiac arrest were entered in the study. ⋯ An increase in the rate of bradycardia and pulseless idioventricular rhythms that was independent of electrical capture or pharmacologic therapy was noted occasionally. Although survival was not enhanced using the AEDP, the device was reliable, easy to use, and free of complications. External cardiac pacing warrants further investigation in the prehospital setting.