Transcutaneous Pacing

• Discuss the indications and contraindications for external cardiac pacing
• Explain the implementation of this form of pacing

Transcutaneous pacing is the delivery of an electrical impulse through the chest wall via cutaneous electrodes to initiate myocardial contraction when intrinsic stimulation fails to maintain adequate cardiac output.  An external pulse generator (usually a combined defibrillator/ECG monitor/pacemaker) produces the stimuli and controls the rate and strength of the impulses which travel along cables and wires to the electrodes which are placed on the chest.

Transcutaneous pacing is a non-invasive procedure which can be quickly and easily applied by trained personnel.  The routine use of pacing is not recommended, however it may be useful during the post resuscitation period as a strategy to manage compromising arrhythmias unresponsive to drug therapy.  Most transcutaneous pacing devices are able to provide demand pacing where the patient’s intrinsic QRS complexes are sensed by the pacing unit and pacing stimuli are only delivered as needed.  If the pacemaker is detecting a lot of artefact due to patient movement etc, this artefact may inhibit the pacemaker and fixed-mode pacing may be required (e.g. during transport).  Gale et al, 2011

In the peri-arrest setting, when the patient’s intrinsic automaticity (electrical impulse) fails to generate adequate cardiac output resulting in the patient becoming symptomatic, treatment is required.  Transcutaneous pacing may be used to provide adequate perfusion when the patient is not responding to drug therapy, for various arrhythmias including:

• Symptomatic bradycardias
• Heart blocks
• Brady-Tachy arrhythmias
• Sinus arrest

• Asystolic cardiac arrest
• Hypothermia → bradycardia is the body’s normal metabolic response to hypothermia.  Also, during hypothermia, the ventricles are prone to fibrillate with any additional stimulation and are more resistant to defibrillation.
• Severe acidosis

ANZCOR Guideline 11.6, 2021