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Bradycardia

Date Last Search Run: Apr 18, 2021
Table last updated: May 02, 2021
Data last added: Apr 30, 2019

Recommendation RECOMMENDATION FOR INTERVENTION
STRENGTH OF EVIDENCE FOR INTERVENTION   SUPPORTIVE (Green) NEUTRAL (Yellow) AGAINST (Red) NOT YET GRADED (White)
1 (strong evidence exists)        
2 (fair evidence exists)    
3 (weak evidence exists)    


Interventions

Anticholinergic
Level Direction Primary Outcome Patient/Process Setting Reference
II Neutral (Yellow) Mortality Patient PH-Paramedic Coon GA., Clinton JE., Ruiz E. Use of atropine for brady-asystolic prehospital cardiac arrest. Ann Emerg Med 1981; 10(9):462-7. Medline
II Neutral (Yellow) Mortality Patient PH-Paramedic Pressley JC., Severance HW Jr., Raney MP., et al. A comparison of paramedic versus basic emergency medical care of patients at high and low risk during acute myocardial infarction. J Am Coll Cardiol 1988; 12(6):1555-61. Medline
II Neutral (Yellow) 30 day mortality Patient PH-Paramedic Schwartz B., Vermeulen MJ., Idestrup C., Datta P. Clinical variables associated with mortality in OOH patients with hemodynamically significant bradycardia. Acad EM 2004; 11:656-61. Medline
III Supportive (Green) Clinical response Patient PH-Paramedic Brady WJ., Swart G., DeBehnke DJ., Ma OJ., Aufderheide TP. The efficacy of atropine in the treatment of hemodynamically unstable bradycardia and atrioventricular block: prehospital and emergency department considerations. Resuscitation 1999; 41(1):47-55. Medline
III Neutral (Yellow) Therapeutic response to atropine Patient PH-Paramedic Swart G., Brady WJ., DeBehnke DJ., Ma OJ., Aufderheide TP. AMI complicated by hemodynamically unstable bradyarrhythmia: Prehospital and ED treatment with atropine. Am J Emerg Med 1999; 17:647-52. Medline

Inotrope
Level Direction Primary Outcome Patient/Process Setting Reference
III Neutral (Yellow) Therapeutic response to atropine Patient PH-Paramedic Swart G., Brady WJ., DeBehnke DJ., Ma OJ., Aufderheide TP. AMI complicated by hemodynamically unstable bradyarrhythmia: Prehospital and ED treatment with atropine. Am J Emerg Med 1999; 17:647-52. Medline

Transcutaneous Pacing
Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) Efficacy Patient Bektas F., Soyuncu S. The efficacy of transcutaneous cardiac pacing in ED. Am J Emerg Med 2016;34(11):2090-3. Medline
II Neutral (Yellow) Survival Patient PH-Paramedic Barthell E., Troiano P., Olson D., Stueven HA., Hendley G. Prehospital external cardiac pacing: A prospective, controlled clinical trial. Ann Emerg Med 1988; 17(11):1221-6. Medline
II Neutral (Yellow) Presenting to the ED with a pulse Patient PH-Paramedic Hedges JR., Syverud SA., Dalsey WC., Feero S., et al. Prehospital trial of emergency transcutaneous cardiac pacing. Circ 1987; 76(6):1337-43. Medline
II Neutral (Yellow) Incidence of liver injury Patient ED-MD Morrison LJ., et al. A randomized controlled feasibility trial comparing safety and effectiveness of prehospital pacing vs conventional treatment: PrePACE. Resus 2008; 76:341-9. Medline
II Neutral (Yellow) Efficacy Patient PH-Paramedic Sherbino J., Verbeek PR., MacDonald RD., Sawadsky BV., McDonald AC., Morrison LJ. Prehospital transcutaneous cardiac pacing for symptomatic bradycardia or bradyasystolic cardiac arrest: a systematic review. Resuscitation 2006; 70(2):193-200. Medline
III Supportive (Green) Extracardiac organ dysfunction Patient ED-MD Inoue T., Takayanagi K., Sakai Y., Hayashi T., Morooka S. Cardiac pacing as emergency care for serious bradyarrhythmia with circulatory shock. J Med 2001; 32(5-6):321-31. Medline
III Supportive (Green) Survival to hospital discharge Patient PH-Paramedic O'Toole KS., Paris PM., Heller MB., Stewart RD. Emergency transcutaneous pacing in the management of patients with bradyasystolic rhythms. J Emerg Med 1987; 5(4):267-73. Medline
III Neutral (Yellow) Therapeutic response to atropine Patient PH-Paramedic Swart G., Brady WJ., DeBehnke DJ., Ma OJ., Aufderheide TP. AMI complicated by hemodynamically unstable bradyarrhythmia: Prehospital and ED treatment with atropine. Am J Emerg Med 1999; 17:647-52. Medline


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