Transcutaneous pacing (TCP) with a Lifepak 12

Image credit: Physio-Control

 

I discovered an interesting quirk about the Lifepak 12 the other day.

I'm sure many of you have been told (as I had been told) that the Lifepak 12 cannot perform TCP unless the limb lead electrodes are attached. There is a caveat to this (reference page 4-18 in the Operations Manual – this is a PDF file so "right-click" the link and select "save as"). If you are performing TCP in demand mode (even if you have it set well below the patient's intrinsic rate and no pacing is being delivered) as soon as the monitor detects "leads off" the monitor will deliver TCP at a fixed rate until the leads are replaced or the pacer is turned off.

For example, say you have a patient with atrial fibrillation and a slow ventricular response of 50 BPM whose ventricular response occasionally drops down to 20 (with 3 – 6 second asystolic pauses during which time the patient loses consciousness and appears peri-arrest). You apply the combo-pads and set the demand pacer for 40 PPM @ 130 mA so that the patient’s heart rate cannot drop below 40 (assuming capture is achieved with 130 mA). The patient’s heart rate stays above 40 so no pacing is delivered.

At the hospital, the nurses (through no fault of their own) remove the ECG leads to switch the patient to their own Lifepak 20. What happens? Answer: The Lifepak 12 delivers fixed rate pacing at 40 PPM @ 130 mA through the combo-pads until the leads are replaced or the pacer is turned off. Not a big deal, just something to be aware of. This is not a device malfunction.

See also:

Transcutaneous pacing (TCP) – The problem of false capture

Using capnography to confirm capture with transcutaneous pacing (TCP)

58 year old male CC: Unconscious (Transcutaneous pacing failure in the setting of hyperkalemia)

Transcutaneous pacing (TCP) for asystole

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Comments
Brian
83 Year Old Male: Shortness of Breath
I mostly agree with dustin. I believe this is may be an isolated posterior MI. The R wave in V2 points to it being a posterior MI. otherwise it is a 1st degree av block with a LAHB. I am somewhat concerned with the concordant t segment depression noted and in fact if you were…
2014-10-30 04:22:44
Karl Brennan
Understanding Amiodarone
Great article , however in VF caused by hyperkalemia it should be avoided along with lidocaine , Since it shuts down the K channels, the eiteiology of the arrest hyper K, K channels are needed to exchange K in the cell. Calcium , Bicarbonate, dextrose and insulin should be used to decrease K levels along…
2014-10-30 03:04:45
Dustin
83 Year Old Male: Shortness of Breath
I see a very sick and complicated patient. 12 Lead: ST elevation in AVR and V1 along with depression in I, II, V4-V6 leading me to an LMCA occlusion. The tall R wave in V2 also points me to Posterior involvement. Posterior MIs and LMCA occlusions can and do cause pulmonary edema, which this patient…
2014-10-30 02:38:21
Adrian
83 Year Old Male: Shortness of Breath
Firstly, the patient is septic, he needs high flow O2 (which he's already receiving), IV fluids, blood cultures and antibiotics (most likely IV) and needs to be in resus sharpish. Secondly, the ECG needs doing again, V2 is wrong and I'm not sure where it's been placed to get that reading. Assuming the rest of…
2014-10-30 01:00:42
Ken Grauer, MD
83 Year Old Male: Shortness of Breath
I see a regular rhythm at ~ 95/minute with LOTS of baseline artifact. I am not certain if there are P waves or not ..... It does look in leads V3,V4 like there are P waves with a long PR interval - but I cannot be certain in lead II that there is an upright…
2014-10-30 00:59:40

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