Transcutaneous Pacing by Emergency Medical Technicians. Executive Summary andFinal Report

摘要

This prospective, controlled trial evaluated whether transcutaneous pacing (TCP)improved the 0 to 3 percent survival rates for cardiac arrest patients with primary asystole, secondary asystole, and idioventricular rhythms. Tested was whether patients in prehospital cardiac arrest who received early TCP from emergency medical technicians (EMTs) had superior clinical outcomes compared to those who did not. Outcomes focused on return of perfusing rhythm, and hospital admission and discharge rates. TCP was initiated prior to medications and intubation, rather than after. A total of 614 patients in cardiac arrest received TCP from September 1987 to June 1990. EMTs initiated TCP for 158 patients. In the intervention group an additional 316 cardiac arrests in primary asystole or initial rhythm ventricular fibrillation (VF) occurred. In the control group a total of 495 cardiac arrests with initial rhythm of asystole or primary VF occurred. Paramedics alone performed TCP for 456 people. The authors concluded that TCP initiated early in advanced life support protocols for patients in full cardiac arrest apparently does not significantly improve survival. The ability to pace with a defibrillator, however, is important and appropriate.