II. Indications
- Refractory Unstable Bradycardia
- Third Degree Atrioventricular Block
- Torsades de Pointes (Overdrive Pacing)
III. Precautions
- Transcutaneous Pacing is a temporizing measure only until definitive transvenous pacing can be achieved
IV. Technique
- Apply pacer pads (Defibrillator/cardioversion pads) in Anterior-Posterior Positioning
- Anterior-posterior position is more likely to achieve capture than anterior-lateral position
- Moayedi (2022) Resuscitation 181:140-146 +PMID: 36410605 [PubMed]
- Moayedi (2022) Circulation 146(14):1103-4 +PMID: 36191069 [PubMed]
- Connect pads to monitor
- Start Procedural Sedation and Analgesia (current >50 mA is intolerable without sedation)
- Turn pacing rate to 60 to 80 bpm or (>30 beats per minute above the patient's intrinsic Heart Rate)
- Set the current starting at 10 mA and increase in 10 mA intervals until capture is indicated on the monitor
- Current of 50 to 100 mA is usually required
- Increase current 10 mA above the capture threshold
- If capture is not reached by current of 120 to 130 mA, stop, reposition pads, and restart at 70 mA
- Confirm capture by checking patient's pulse or POCUS Chest
- Pulse Oximeter may register a false pulse due to Muscle Twitches despite lack of cardiac capture
V. Resources
- Transcutaneous Pacing (Nickson, Life in the Fastlane)
- Transcutaneous Pacing (Open Anesthesia)
VI. References
- Moayedi and Swaminathan in Swadron (2023) EM:Rap 23(5): 8-9