Percussion pacing--an almost forgotten procedure for haemodynamically unstable bradycardias? A report of three case studies and review of the literature.

More than 80 years after its first description by Eduard Schott, percussion (fist) pacing remains a little known procedure even though it represents an instantly available and easy to perform treatment for temporary emergency cardiac pacing in haemodynamically unstable bradycardias, including bradycardic pulseless electrical activity and complete heart block with ventricular asystole. Based on the Consensus on Science and Treatment Recommendations of the International Liaison Committee on Resuscitation, the European Resuscitation Council recently incorporated percussion pacing in its advanced life support guidelines (Nolan and colleagues, Resuscitation 67 (Suppl 1): S39-S86, 2005). Here, we briefly describe three of our own cases and present a review of the literature on percussion pacing with respect to the available evidence on its efficacy, its practical application, and clinical indications.