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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EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation

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Darren Earley
38 Year Old Male – Chest Pain and Leg Paralysis.
Ventricular pre excitation.
2015-10-05 18:23:40
38 Year Old Male – Chest Pain and Leg Paralysis.
i am with Brian on the aortic dissection. there are a lack of p waves that are possibly due to a 1st. degree heart block.
2015-10-05 17:50:11
Conclusion: 38 Year Old Male – Chest Pain and Leg Paralysis.
Really good case i learned alot reading that if i get one i have the choice of one hospital with no cardio thoracic surgeon so it will be a heli to the nearest one.
2015-10-05 16:34:40
Brooks Walsh MD
38 Year Old Male – Chest Pain and Leg Paralysis.
For sure, in severe chest pain you must consider PE! The vital signs and ecg did not, in this case, support that diagnosis, but patients don't always "read the textbook." Read the conclusion, see what you think!
2015-10-05 14:50:05
Joe Moore
38 Year Old Male – Chest Pain and Leg Paralysis.
I don't know the answer, but I'm going to put something into this discussion related to a pulmonary embolism. I've had one. The pain was "tearing, and 10/10 and radiating to the back. Pulse oximeter was 85, and 12-lead suggested ischemia. Fortunately, the local hospital was able to treat, but I spent one long night…
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