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
Shay
59 Year Old Male: Unwell
I'll go with A-fib with RVR, and an Anterior/Septal/Inferior MI. TX the MI since it's the worst of the evils, and I'm willing to bet the A-Fib may be a result of irritation from the MI. ASA, IV x 2, 1000mL bolus, Nitro when his BP finally supports it (though I doubt it ever will,…
2015-06-30 19:52:56
Steve
59 Year Old Male: Unwell
Afib is a possibility but the differentials for a wide complex tachycardia have always been said to be: 1:VT 2; VT 3: VT 4:VT 5: abberency Especially since he has no reported history of afib. Show a 12lead to 5 cardiologist and get 6 different readings. Stop with the elitist attitude.
2015-06-30 14:41:04
Steve
59 Year Old Male: Unwell
The differentials for a wide complex tachycardia. 1:VT 2; VT 3: VT 4:VT 5: sinus with abarency Since he's the right age, doesn't have history of afib, and MIs can cause VT, I'm leaning towards VT. Luckily treatment for unstable tachycardiaI is the same : shock. If it IS afib, it's doubtful he's been in…
2015-06-30 14:32:39
Martin
59 Year Old Male: Unwell
Had a very similar case and EKG just the other day. Docs called it BBB. They pushed calcium chloride and Bicarb and it started to narrow down after 20mins. Luckily I was 3 mins to ER "didn't push anything cause I didn't have time." aka..i didn't know what it was.
2015-06-30 13:40:01
Stephen Smith
59 Year Old Male: Unwell
Not VT. This is atrial fib with RVR and anterolateral STEMI in the presence of RBBB/LAFB. Possible superimposed hyperK. Needs cardioversion, then repeat ECG. STEMI can sometimes be due to demand ischemia and one must repeat the ECG after rapid rate is slowed.
2015-06-30 12:45:31

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