title: Transthoracic pacing during CPR.
abstract: Twenty-seven patients had transthoracic pacemakers inserted by the subxiphoid approach during advanced cardiopulmonary resuscitation (CPR) in the emergency department of Detroit General Hospital between May 1977 and March 1979. Twenty-one charts were available for detailed review. Pacemaker indications in these 21 cases included electromechanical dissociation in four cases, asystole in 10 cases, pulseless idioventricular rhythm in five cases, and 3 degree heart block in two cases. All patients had failed to respond to conventional chronotropic and inotropic agents prior to pacemaker insertion. Good pacemaker capture was obtained in eight of the 21 patients. Two of the patients with good capture had pulses for about 15 min after capture. One of these two patients rearrested, with signs of pericardial tamponade which was confirmed during emergency thoractomy. Neither of the two patients who had pulses after pacemaker insertion and capture could be stabilized, and both died within 30 min post-insertion. Transthoracic pacemaker insertion during advanced CPR in the emergency department probably does not improve outcome in bradyasystolic arrests if there has been poor response to standard advanced cardiac life support management.
mesh_terms: D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000628:therapy*; D002316:Cardiotonic Agents / Q000627:therapeutic use; D004630:Emergencies; D005069:Evaluation Studies as Topic; D005260:Female; D006323:Heart Arrest / Q000628:therapy; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D012151:Resuscitation
chemical_list: D002316:Cardiotonic Agents