Review of: Sherbinoa J, Richard Verbeeka PR, MacDonalda RD, et al: “Prehospital transcutaneous cardiac pacing for symptomatic bradycardia or bradyasystolic cardiac arrest: A systematic review.” Resuscitation. 70:193 200, 2006.
The authors reviewed the literature to examine the value of transcutaneous cardiac pacing for symptomatic bradycaridia and bradyasystolic arrest. They searched Medline and, based on their criteria, they identified 34 articles that addressed the issue. However, they selected only seven for review because of various deficiencies in the others.
They determined that the quality of the studies for all seven of these trials was poor. They further concluded that there is no evidence to support the use of pacing for either of these conditions.
The first thing to remember when reading a research conclusion is this: The absence of evidence is not the evidence of absence. What I mean is just because you can t find any literature to support a given intervention does not mean that the intervention has no value. This is what s meant by Class Indeterminate.
In relation to this study, the seven studies the authors chose were published between 1983 and 1992. The AHA guidelines have gone through substantial changes since then. What inferences can we make by the fact that pacing had no impact on cardiac arrest survival using 25-year-old protocols? Additionally, the seven articles chosen did not have sufficient numbers of cases in either group to make statistical analysis possible.
Advances in the uses of pharmacologic agents, such as atropine and vassopressors, will certainly change the role of pacing. However, instead of saying that the literature doesn’t support the use of pacing, I wish the researches would just say, “We don’t know what the answer is.”