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Ultrasound-Guided Pacing


In 2005 the American Heart Association removed pacing asystole from the cardiac arrest algorithm. This action was a result of multiple studies (1,2) showing no benefit. These studies are full of limitations such as:

  • Mechanical capture not recorded or confirmed

  • Significant delays in initiation

  • Including all-comer asystolic patients

The difference between pacing bradycardia versus asystole becomes blurrier as the heart rate decreases. For example, consider these three scenarios:


You have a patient with a heart rate of 40, blood pressure 70/39, and unresponsive. Are you ok with pacing?


You have a patient with a heart rate of 30, blood pressure 68/34, and unresponsive. Are you ok with pacing?