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  • Tom Bouthillet

A Rare Case of Transcutaneous Pacing (TCP) with True Electrical and Mechanical Capture

Updated: Nov 18, 2021

EMS is called to an assisted living facility for a 79-year-old female who is found collapsed outside her apartment door.

On arrival, the staff is providing adequate chest compressions.

The cardiac monitor is attached.

The arrest rhythm is asystole.

Chest compressions are continued, an IV is initiated, and 1 mg of epinephrine is given.

Now there is a regular bradycardic rhythm without P-waves at a rate of 30.

The patient has a faint pulse but a blood pressure cannot be auscultated. The patient is prepared for transcutaneous pacing (TCP).

The computer is successfully identifying and marking the R-waves.

The pacer is set to 80 PPM and paramedics report capture at 110 mA.

The presence of broad T-waves indicates true electrical capture.

With this rhythm there are pulses that correspond with the monitor (not always accurate), there is an SpO2 waveform, and the NIBP is 118/68.

Unfortunately, the patient did not survive to hospital discharge.

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About Me

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I am the Battalion Chief of EMS for Hilton Head Island Fire Rescue and obsessed with all things process improvement, system performance, human factors, crew resource management, and evidence-based performance measures for time-sensitive diagnoses.

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