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Comment & Response
June 28, 2021

Advanced Cardiac Life Support Algorithms—Reply

Author Affiliations
  • 1Division of Cardiology, Department of Medicine, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University, School of Medicine, Cleveland, Ohio
  • 2Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, Charlottesville, Virginia
  • 3Division of Cardiology, Department of Medicine, Louis Stokes Cleveland Veterans Affairs Medical Center, Case Western Reserve University, Cleveland, Ohio
JAMA Intern Med. 2021;181(8):1141-1142. doi:10.1001/jamainternmed.2021.3174

In Reply We appreciate the insightful comments by Gallen et al in response to our article.1 We would like to thank JAMA Internal Medicine for the opportunity to respond to them.

In their letter, Gallen et al comment on the possibility that transcutaneous pacing (TCP) could temporize the decompensated hemodynamics due to significant bradyarrhythmia. Traditionally, the efficacy of TCP for bradyarrhythmic cardiac arrest was thought to be equally limited in both prehospital and inpatient settings.2 In the scenario of prehospital cardiac arrest, which is usually not witnessed, chest compression has been shown to be the most important aspect of resuscitation, and TCP could potentially divert the focus from the effectiveness of chest compression. Therefore, the conventional adult basic and advanced cardiac life support (ACLS) guideline does not recommend TCP for patients with bradyarrhythmic cardiac arrest that occurs before hospital admission.3

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