Out-of-hospital transcutaneous pacing by emergency medical technicians in patients with asystolic cardiac arrest

Article Abstract:

Transcutaneous pacemakers may not improve survival in patients who go into cardiac arrest outside a hospital. Transcutaneous pacemakers stimulate the heart through electrodes placed on the chest. Some doctors believe that these pacemakers should be carried on all ambulances. Emergency medical technicians (EMTs) in 16 fire districts were taught to use transcutaneous pacemakers on people in cardiac arrest (the intervention group) and EMTs in 23 other fire districts were taught to give the usual treatment (the control group). During the study, 506 cardiac arrests occurred in the intervention group and 550 in the control group. Only 158 patients in the intervention group received the pacemaker, but their survival rates were no better than those in the control group. This was true even though the average time from collapse to the start of pacing was only nine minutes. It seems premature to recommend that every ambulance carry a transcutaneous pacemaker. Each pacemaker costs $4,000 to $7,000.

Care and treatment, Evaluation, Cardiac pacing

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A comparison of standard-dose and high-dose epinephrine in cardiac arrest outside the hospital

Article Abstract:

High-dose epinephrine may not be a more effective treatment than standard-dose epinephrine for treatment of patients who suffer cardiac arrest outside the hospital. Among 1,280 patients who suffered cardiac arrest outside the hospital, 648 were treated with 0.2 milligrams (mg) of intravenous (IV) epinephrine per kilogram of body weight and 632 were treated with 0.02 mg of IV epinephrine per kg of body weight. Thirty-three percent of the patients treated with high-dose epinephrine experienced a spontaneous return of circulation, compared to 30% of those treated with standard-dose epinephrine. Twenty-two percent of the patients in each of the treatment groups survived to be admitted to the hospital. Five percent of the patients in the high-dose treatment group survived to be discharged from the hospital, compared to four percent of those in the standard-treatment group. Treatment with high-dose epinephrine did not significantly improve neurological outcome.

Health aspects

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A comparison of repeated high doses and repeated standard doses of epinephrine for cardiac arrest outside the hospital

Article Abstract:

High-dose epinephrine appears to be no more effective than the standard dose for treating people in cardiac arrest. Researchers randomly assigned 3,327 people who had a cardiac arrest outside a hospital to receive several doses of 5 milligrams of epinephrine or the standard dose of 1 milligram. In both groups, similar percentages of patients recovered, survived to be admitted to a hospital and survived to be discharged from the hospital.

Dosage and administration

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