Successful use of percussion pacing in a pre-hospital p-wave asystole and ventricular standstill

Unstable emergency patients might experience different cardiac arrhythmias. A rarely seen arrhythmia is the p-wave asystole also mentioned ventricular asystole, ventricular standstill or third-degree atrioventricular block with no ventricular escape rhythm. Here, atrial depolarisation is being displayed on the ECG as the only cardiac activity resulting in a patient with no palpable pulses and no consciousness. Left untreated, this arrhythmia will result in cardiac arrest within seconds. Of 2333 patients with non-shockable rhythm cardiac arrest, 6,13% have been described to have p-wave asystole as their initial rhythm (Hulleman et al, 2016). European Guidelines for resuscitation 2015 recommends percussion pacing (PP) as an initial intervention for haemodynamically unstable patients with p-wave asystole or bradyarrhythmias until other means of cardiac pacing are commenced (Soar et al, 2015: 110, 116). The intervention is not scientifically supported and only case reports and reviews of case reports have been published. Our case report contributes to these describing a patient with syncope witnessed by EMS, presenting with p-wave asystole and ventricular standstill, treated successfully with PP and thereof palpable carotid pulses and rise in consciousness.