Peri-Arrest Bradycardia Management

If a single dose is ineffective → repeat every 3-5 min up to 6 doses (3 mg in total), then move to step 2

• Isoprenaline infusion
• Adrenaline infusion

• Transcutaneous (transthoracic) pacingQuick, non-invasive method to deliver electrical impulses to the heart via external electrode pads on the chest. Note it is not always reliable in achieving consistent cardiac capture, success rate varies from 50-80%, depending on various factors. Transcutaneous pacing is also uncomfortable for patients, often requiring sedation or analgesia. can be used as a bridge or when transvenous pacing is not readily available
• Transvenous pacingInvasive method to deliver electrical impulses to the heart where pacing leads is inserted through a central vein (often subclavian or internal jugular vein) and advanced into the right ventricle. It is not as quick as transcutaneous pacing to set up, but is more comfortable and effective for longer-term use. is the preferred management (early transvenous pacing should be established in unstable patients with symptomatic bradycardia)

If both transcutaneous and transvenous pacing are not immediately available (and drugs are ineffective) → fist pacing can be attempted while waiting for pacing equipment