Objective:Transcutaneous cardiac pacing (TCP) is known to be efficacious in sustaining patients with high-degree atrioventricular block. The purpose of this study was to describe EMS systemwide application of TCP and determine its cost effectiveness.Methods:We performed a retrospective review of patient records from an urban, municipal, advanced life-support (ALS) EMS system during the first year (1993) of systemwide application of TCP. From each record, we determined patient age and gender;

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... diac rhythm, heart rate (HR), and systolic blood pressure (SBP) prior to pacing; absence or presence of a pulse while pacing; time interval to a hospital while pacing; HR and SBP during pacing and on arrival at the hospital. We determined the fixed and variable costs to the system for implementing and maintaining the TCPs.Results:During the study period, the EMS system responded to 60,242 emergency calls. Transcutaneous pacing pads were applied to 69 patients, and TCP was attempted for 60 patients (mean ±SD age 67.1±14.7 years).Transcutaneous cardiac pacing resulted in a positive outcome for 11 patients who achieved and maintained electromechanical capture and a pulse until arrival at a hospital (mean age 66±8 years). For this group the mean HR and SBP were 44±38 beats per minute (BPM) and 31±38 mm Hg, respectively prior to pacing and were 78±28 BPM and 101.2±36.7 mmHg, respectively, on arrival at the hospital. These patients were paced for 10.5±10 minutes prior to the hospital. The annual cost of TCP for the EMS system was [US] $5,435 ($4,400 fixed costs, plus $1,035 variable costs).Conclusion:The results suggest that TCP is a valuable adjunct for patients suffering from atrioventricular blocks and junctional rhythms, but not for idioventricular or asystolic rhythms. For this urban EMS system the cost of TCP is approximately $494 per positive patient outcome.