Using capnography to confirm capture with transcutaneous pacing (TCP)

Those of you who have been following me for a while (here and other online forums) know that I have searching for cases where a patient was successfully paced with a Lifepak 12.

I have reviewed dozens of cases where the treating paramedic thought the patient was being paced, but the rhythm strips showed only false capture.

Imagine my surprise when Robbie Murray (Operations Chief for Sussex County EMS) taught a capnography class for Hilton Head Island Fire & Rescue!

It was a wonderful class, and I learned a lot about capnography, but the part that really stood out was a couple of rhythm strips that showed TCP with true electrical capture!

That’s just something you don’t see every day. Trust me on this point. I’ve been paying attention!

Robbie was gracious enough to email them to me so I could share them with you.

Apparently for this intubated patient, there was a marked rise in CO2 as soon as electrical (and mechanical) capture was achieved. What a novel and interesting use of waveform capnography!

One thing I’d like to point out is that both of these rhythm strips show TCP @ 140 mA! That’s important because the most common mistake I’ve seen with TCP is failure to increase the milliamperes high enough to achieve electrical capture.

Yours truly captured @ 120 mA with the Lifepak 12.

So, chalk up another “score” for waveform capnography and thanks again to Robbie Murray for sharing these interesting rhythm strips!

See also:

Transcutaneous pacing (TCP) The problem of false capture

Transcutaneous pacing (TCP) with a Lifepak 12

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

Transcutaneous pacing (TCP) for asystole

4 Comments

  • Must be nice to be able to pace and monitor wave form ETCO2 simultaneously. Our Zoll M-series monitors do not have this as an option, however, the numeric reading may still be used.

  • Christopher says:

    They could show II, SpO2, and CO2 on the LP12. Could even show II, SpO2 and a trend graph of CO2 over time.

  • Bill says:

    Great stuff. It really makes sense though. We are taught that a ROSC will be reflected by an increase in ETCO2 numbers, so will mechanical capture. It is not spontaneous circulation but it is much more efficient than beating on the chest!

    Reminds of a call where we had a ROSC and nobody believed me. I assured them that a jump from 20 or so to 60 on the ETCO2 certainly indicated ROSC whether they had a palpable pulse/BP or not. Same applies here.

    Makes me wonder. Any studies around that show maximum sustainable blood pressures obtained from performing good, solid compressions?

  • TatonkaDTD says:

    Am I missing something here?  There's no significant difference between the ETCO2 in the two waveforms presented…only the scales are different…are both of these with successful capture?  If so, what was the ETCO2 prior to getting mechanical capture?

4 Trackbacks

Leave a Reply

Your email address will not be published. Required fields are marked *

EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation
Comments
David Baumrind
All that wiggles isn’t Wellens’
@Gary, by all means, nitpick all you like. I agree with your assessment, and the post has been modified. Thank you for the feedback!
2014-08-30 17:28:16
Gary Huntress
All that wiggles isn’t Wellens’
Not to nitpick but is this really a "slightly leftward axis"? I and AVF are both positive. I put it at about +20 degrees, not leftward.
2014-08-30 11:49:35
Handsome Robb
87 YOM COMPLAINING OF CHEST DISCOMFORT AND DYSPNEA
CHF. 12-lead shows a sinus Tachycardia in the 120s with PACs, besides the anterior leads there's diffuse ST depression, the STE in the anterior leads can be explained by the LBBB, axis is good as well. I wish they posted the EtCO2 waveform so we could see but I'm assuming it's non-obstructive. The elevated EtCO2…
2014-08-30 08:08:22
Christopher Watford
“Bad heartburn” – 82 y.o. female without chest pain.
Brooks, Firstly, thank you for the warm welcome to the club. Secondly, the Glasgow algorithm's only published sens/spec for AMI is 51.6%/97.6% respectively (Tuscon STEMI Database). I've not been able to find any other publications. The GE Marquette 12SL algorithm has been widely studied, but is much older, and ranges in sensitivity from 48% to…
2014-08-29 16:50:14
CB
57 Year Old Male–Chest Discomfort
Given what he was doing (paint fumes on ladder painting) I would first question if the pain is reproducable. Yes his ekg isn't normal but looks like old inferior MI. And he is hypertensive. 02 a must. Def. would give ASA. First would give morphine and see how his cp and bp are. If still…
2014-08-29 11:37:25

STEMI Expert?

  • Click here to find out!
  • 12-Lead ECG Challenge Smartphone App

    Photobucket

    12-Lead ECG Challenge Smartphone App - $5.99

  • Apple iOS
  • Android
  • Amazon
  • Web Based

  • FRN-TV video review
  • iMedicalApps.com review
  • Interested in resuscitation?

    FireEMS Blogs eNewsletter

    Sign-up to receive our free monthly eNewsletter

    Visitor Map / Stats

    Locations of visitors to this page


    LATEST EMS NEWS

    HOT FORUM DISCUSSIONS