Efficacy and safety of non-permanent transvenous pacemaker implantation in an intensive care unit

• Published in: Medicina intensiva Vol. 35; no. 7; p. 410
• Main Authors: Muñoz Bono, J, Prieto Palomino, M A, Macías Guarasa, I, Hernández Sierra, B, Jiménez Pérez, G, Curiel Balsera, E, Quesada García, G
• Format: Journal Article
• Language: Spanish
• Published: Spain 01.10.2011
• Subjects: Aged; Aged, 80 and over; Atrioventricular Block - therapy; Clinical Competence; Comorbidity; Critical Care - methods; Electrodes, Implanted; Female; Femoral Vein; Heart Rupture - epidemiology; Heart Rupture - etiology; Hematoma - epidemiology; Hematoma - etiology; Humans; Length of Stay - statistics & numerical data; Male; Middle Aged; Pacemaker, Artificial; Prospective Studies; Prosthesis Implantation - adverse effects; Prosthesis Implantation - methods; Psychomotor Agitation - epidemiology; Psychomotor Agitation - etiology; Risk Factors
• DOI: 10.1016/j.medin.2011.04.003

To analyze the clinical indications for use, morbidity and mortality associated with a non-permanent transvenous pacemaker. Prospective and observational study. Cardiac intensive care unit. One hundred and eighty-two patients with non-permanent pacemakers implanted consecutively over a period of four years. Main variables of interest were demographic data, clinical indications, access route, length of stay and complications. A total of 63% were men, with a median age of 78 ± 9.5 years and with symptomatic third-degree atrioventricular block in 76.9% of the cases. Femoral vein access was preferred in 92.3% of the cases. Complications appeared in 40.11% of the patients, the most frequent being hematoma at the site of vascular access (13.19%). Restlessness was associated to the need for repositioning the pacemaker due to a shift in the electrode (p=0.059) and to hematoma (p=0.07). Subclavian or jugular vein lead insertion (p=0.012; OR=0.16; 95%CI, 0.04-0.66), restlessness during admission to ICU (p=0.006; OR=3.2; 95%CI, 1.4-7.3), and the presence of cardiovascular risk factors (p=0.042; OR=5; 95%CI, 1.06-14.2) were identified by multivariate analysis as being predictors of complications. Length of stay in ICU was significantly longer when lead insertion was carried out by specialized staff (p=0.0001), and in the presence of complications (p=0.05). Predictfurors of complications were restlessness, cardiovascular risk factors, and insertion through the jugular or subclavian vein. Complications prolonged ICU stay and were not related to the professionals involved.