Prehospital Cardiac Pacing Increases Mortality Risk

TOPLINE:

A recent study has found prehospital transcutaneous cardiac pacing (TCP) in patients with bradycardia to be associated with a high mortality rate of 63.4%, and TCP failure associated with increased body weight, non-bradycardic initial heart rate, and pre-TCP hypoxia.

METHODOLOGY:

• Deidentified electronic health record (EHR) data of 13,270 patients (median age, 71 years; 55% men) who received prehospital TCP were obtained from the 2018-2021 ESO Data Collaborative and analyzed.
• Patients were divided into two groups: Those who received TCP and did not have a cardiac arrest and those who received TCP and had a cardiac arrest.
• Outcome measures were TCP failure (progression to cardiac arrest), defined as the initiation of prehospital cardiopulmonary resuscitation (CPR) following the first TCP attempt, and mortality prior to hospital discharge.

TAKEAWAY:

• TCP failure occurred in 20.4% patients, with a median 4.7-minute interval between TCP initiation and CPR initiation.
• Among patients who underwent prehospital TCP, 63.4% died or were discharged to hospice, 27.4% returned home, and the others were transferred to various care facilities, majorly for cardiac arrest.
• Factors associated with TCP failure included increased body weight (> 100 kg; adjusted odds ratio [aOR], 1.33), a non-bradycardic initial heart rate (> 50 bpm; aOR, 2.87), and pre-TCP hypoxia (< 80% SpO2; aOR, 6.01).

IN PRACTICE:

“Patients who undergo prehospital TCP are at high risk of mortality. Progression to cardiac arrest is common and associated with factors including increased weight, a non-bradycardic initial heart rate, and pre-TCP hypoxia,” wrote the authors.

SOURCE:

The study was led by Tanner Smida, West Virginia University, Morgantown, West Virginia. It was published online on August 16, 2024, in Prehospital Emergency Care.

LIMITATIONS:

The use of EHR data not collected for research purposes may have introduced bias due to missing data or variable documentation practices. Excluding patients with missing intervention timing data and outcome data may have led to selection bias and limited the generalizability of the findings. The inability to control for the milliamperes of current delivered to each patient and the position of electrotherapy pads on the thorax may have affected the results. The lack of access to continuous waveform data limited the ability to validate the accuracy of the documented vital signs.

DISCLOSURES:

The study was supported by grants from the National Institute of General Medical Sciences of the National Institutes of Health. One of the authors is an employee of ESO. The authors declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.