We investigated the use of transvenous (TV) and transmyocardial (TM) pacemakers in the emergency department (ED) in 54 adult patients (42 men and 12 women) with bradyasystolic cardiac arrest. Down time prior to cardiopulmonary resuscitation (CPR) was 4.8 +/- 4.3 minutes. Time in the ED prior to pacer insertion was 26.9 +/- 17.7 minutes. Electrical capture rate was 63%. Pulse developed in 5%. Only 1.2% were admitted, and none was discharged alive. There was no significant difference in capture rate for TV versus TM pacers or in capture rate whether the pacer was inserted early or late after ED arrival. We conclude that ED pacer insertion for such patients does not alter survival rates.