| In monitored patients with onset of a non-perfusing rhythm such as asystole or extreme bradycardia (figure 1), percussion (fist) pacing may be deployed as an alternative to external pacing when successful perfusion is confirmed by a continuous arterial tracing, pulse oximetry and ECG. | IIb | C |
| Percussion pacing should be performed at a rate of 50–70 per minute and the ulnar side of a clenched fist should be used to strike the chest from 20–30 cm above the left lower sternal edge, in order to mechanically increase the right atrial pressure, if measured, by 15–20 mm Hg. | IIb | C |