Prehospital Cardiac Pacing Linked to High Mortality Rate in Patients With Bradycardia

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).

 

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.

 

https://www.medscape.com/viewarticle/prehospital-cardiac-pacing-linked-high-mortality-rate-2024a1000fvp