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

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Comments
iliyas
Masters Case #01: 50 Year Old Male – Severe Chest Pain
Short runs of V.T LAD LAHB Widespread st depression with St elevation in avr Lf msin / three vessle disease Not sure about rhythm
2015-08-26 06:34:44
Darren Earley
Masters Case #01: 50 Year Old Male – Severe Chest Pain
1. L.A.D 2. De Winters (ST Elevation aVR, ST abnormality V2-3). 3. Non sustained VT 4.Poor quality ECG so cannot say about p waves or whether A.fib. Pre alert for ppci = evolving occlusion of LAD artery. Aspirin. Pain relief. Diesel
2015-08-25 17:26:50
michelle
Masters Case #01: 50 Year Old Male – Severe Chest Pain
first pt. sat's are to low at 94% for just room air pt. needs hi-flow o2 at 15 lt. min. i see a-fib. with runs of 3. st depression. there is also a chance of pheumonia. after o2 administer fluids, a chest x-ray, monitor the heart and ekg especially where bp is low.
2015-08-25 16:57:39
Ivan Rios
Understanding Adenosine (Adenocard)
Correct, even for stress test, with the same purpose.
2015-08-18 17:07:24
Joppe
Understanding Adenosine (Adenocard)
Adenosine is also used to measure FFR in the cathlab to achieve maximum vasodilation in the vessels in the Heart.
2015-08-18 16:02:13

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