Corresponding author: Han Xiaotong, Department of Emergency, Hunan Provincial People's Hospital (First Affiliated Hospital of Hunan Normal University), Changsha 410005, Hunan, China, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2023 Jul;35(7):678-683. doi: 10.3760/cma.j.cn121430-20230228-00124.
Temporary cardiac pacing is an essential technique in the diagnosis and treatment of arrhythmias. Due to its urgency, complexity, and uncertainty, it is necessary to develop an evidence-based emergency operation norms. Currently, there is no specific consensus guidelines at home or abroad. The Emergency Branch of Chinese Medical Association organized relevant experts to draft the Chinese emergency expert consensus on bedside temporary cardiac pacing (2023) to guide the operation and application of bedside cardiac pacing. The formulation of the consensus adopts the consensus meeting method and the evidentiary basis and recommendation grading of the Oxford Center for Evidence-based Medicine in the United States. A total of 13 recommendations were extracted from the discussion on the methods of bedside temporary cardiac pacing, the puncture site of transvenous temporary cardiac pacing, the selection of leads, the placement and placement of leads, pacemaker parameter settings, indications, complications and postoperative management. The recommended consensus includes the choice between transcutaneous and transvenous pacing, preferred venous access for temporary transvenous pacing, the target and best guidance method for implantation of bedside pacing electrodes, recommended default pacemaker settings, recommended indications for sinoatrial node dysfunction, atrioventricular block, acute myocardial infarction, cardiac arrest, ventricular and supraventricular arrhythmias. They also recommended ultrasound guidance and a shortened temporary pacing support time to reduce complications of temporary transvenous cardiac pacing, recommended bedrest, and anticoagulation after temporary transvenous pacing. Bedside temporary cardiac pacing is generally safe and effective. Accurate assessment, correct selection of the pacing mode, and timely performance of bedside temporary cardiac pacing can further improve the survival rate and prognosis of related emergency patients.
临时心脏起搏是心律失常诊断和治疗中的一项重要技术。由于其紧迫性、复杂性和不确定性，制定基于证据的急诊操作规范很有必要。目前，国内外尚无具体的共识指南。中华医学会急诊分会组织相关专家起草了《中国床边临时心脏起搏急诊专家共识（2023）》，以指导床边心脏起搏的操作与应用。该共识的制定采用共识会议法以及美国牛津循证医学中心的证据基础和推荐分级。从床边临时心脏起搏方法、经静脉临时心脏起搏穿刺部位、导线选择、导线置入与放置、起搏器参数设置、适应证、并发症及术后管理等方面的讨论中，共提炼出13条推荐意见。推荐的共识包括经皮起搏与经静脉起搏的选择、临时经静脉起搏的首选静脉通路、床边起搏电极植入的目标及最佳引导方法、推荐的起搏器默认设置、窦房结功能障碍、房室传导阻滞、急性心肌梗死、心脏骤停、室性及室上性心律失常的推荐适应证。还推荐超声引导并缩短临时起搏支持时间以减少临时经静脉心脏起搏的并发症，推荐临时经静脉起搏后卧床休息及抗凝。床边临时心脏起搏总体安全有效。准确评估、正确选择起搏模式并及时进行床边临时心脏起搏可进一步提高相关急诊患者的生存率和预后。
