Arguably, one of the weak links in the Chain of Survival is the instigation of bystander CPR. The experience of King County with high rates of bystander CPR is associated with impressively high survival rates (AHAN, 2015).
The principles of Crisis Resource Management (CRM) aim to mitigate the risks associated with a potential crisis and improve patient safety. Effective teamwork and communication are key CRM elements in emergency care medicine.
The use of percussion pacing (PP) using a clenched fist as an external cardiac pacemaker is not scientifically supported. However, European Guidelines for resuscitation 2015 recommend PP as an initial intervention for haemodynamically unstable patients with bradyarrhythmias or p-wave asystole. We describe a case where paramedics witnessed a patient developing p-wave asystole with ventricular standstill, and treated the patient successfully with PP until transcutaneous pacing was established.
An 87-year-old man with a previous history of bifascicular heart block collapsed in his private residence in Denmark. Initially conscious and clinically unstable when assessed by Emergency Medical Services (EMS), his condition quickly deteriorated and lost consciousness. PP was initiated resulting in electric capture in shape of broad QRS complexes on the ECG tracing corresponding with palpable carotid pulses and rise in consciousness. The successful intervention lasted for 20 seconds until transcutaneous pacing was commenced and further treatment was established. The patient survived to hospital admission.
Although current research has not been able to establish a scientific base for the use of PP in extreme bradycardia and p-wave asystole, several case reports have been published. We contribute to these with our description of an 87-year-old man who benefited from this easy to use and probably life-saving intervention. To our best knowledge, this is the first case report of Danish paramedics intervening with PP.
The number of homeless adults on our streets is increasing which, due to their associated health problems, is causing increasing demand and inefficiencies on the National Health Service (NHS).