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. 2025;29(5):578-585.
doi: 10.1080/10903127.2024.2393768. Epub 2024 Sep 4.

Prehospital Transcutaneous Cardiac Pacing in the United States: Treatment Epidemiology, Predictors of Treatment Failure, and Associated Outcomes

Tanner Smida  1 , Laura Voges  2 , Remle Crowe  3 , James Scheidler  2 , James Bardes  2   4
Affiliations

Prehospital Transcutaneous Cardiac Pacing in the United States: Treatment Epidemiology, Predictors of Treatment Failure, and Associated Outcomes

Tanner Smida et al. Prehosp Emerg Care. 2025.

Abstract

Objectives: Transcutaneous cardiac pacing (TCP) is a potentially lifesaving therapy for patients who present in the prehospital setting with bradycardia that is causing hemodynamic compromise. Our objective was to examine the outcomes of patients who received prehospital TCP and identify predictors of TCP failure.

Methods: We utilized the 2018-2021 ESO Data Collaborative public use research datasets for this study. All patients without a documented TCP attempt were excluded. Mortality was derived from hospital disposition data. TCP failure was defined as the initiation of CPR following the first TCP attempt among patients who did not receive CPR prior to the first TCP attempt. Multivariable logistic regression models using age and sex as covariables were used to explore the association between prehospital vital signs and TCP failure.

Results: During the study period, 13,270 patients received transcutaneous pacing and 2560 of these patients had outcome data available. Overall, the mortality rate following TCP was 63.4%. Among patients who did not receive CPR prior to the first TCP attempt (n = 7930), TCP failure (progression to cardiac arrest) occurred 20.4% of the time. Factors associated with TCP failure included increased body weight (>100 vs. 60-100 kg, aOR: 1.33 (1.15, 1.55)), a pre-pacing non-bradycardic heart rate (>50 vs. <40 bpm, aOR: 2.87 (2.39, 3.44)), and pre-TCP hypoxia (<80% vs. >90% SpO2, aOR: 6.01 (4.96, 7.29)).

Conclusions: 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.

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Conflict of interest statement

DECLARATION OF INTEREST: RPC is an employee of ESO. The aims of this investigation were reviewed by an independent committee before access to the data was granted. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the results reported in this paper.

Figures

Figure 1:
Figure 1:
Flow diagram describing inclusion criteria and stratification of patients for outcome reporting. This figure displays inclusion criteria for our study in addition to our stratification of patients for outcome reporting. Patients were stratified as either receiving TCP after prehospital CPR, TCP prior to prehospital CPR, or TCP with no prehospital CPR.
Figure 2:
Figure 2:. Temporal distribution of 9–1-1 calls that resulted in transcutaneous pacing.
This figure displays the temporal distribution of 9–1-1 calls that results in transcutaneous pacing. Panel A displays the distribution of cases by hour of day, stratified by year. Panel B displays the distribution of cases by month, stratified by year.
See this image and copyright information in PMC

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