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Podcast 166 - Transcutaneous Pacing & False Capture

In this episode, we discuss a recent paper on false electrical capture and pre-hospital transcutaneous pacing by paramedics. The guests, Tom Boutilet, Josh Kimbrell, and Judah Kreinbrook, discuss their research findings and the implications for paramedics. They conducted a retrospective study and found that paramedics often mistakenly believe they have electrical capture when they do not.


They emphasize the importance of confirming electrical capture before assuming mechanical capture. They also discuss the challenges of pulse palpation and the need for more rigorous research in EMS and ED settings. The conversation discusses the challenges and considerations in transcutaneous pacing, specifically focusing on verifying mechanical capture. The speakers explore using various methods to confirm mechanical capture, such as feeling for a pulse, pulse oximetry, and ultrasound.


They also discuss the difficulty of accurately assessing mechanical capture and the potential for false electrical capture. The conversation concludes with a discussion on the transfer of pacing from one device to another and the importance of verifying capture during the process.


Check out more from Josh, Judah, and Tom at EMS12LEAD.com.




References:

Kimbrell J, Kreinbrook J, Poke D, Kalosza B, Geldner J, Shekhar AC, Miele A, Bouthillet T, Vega J. False Electrical Capture in Prehospital Transcutaneous Pacing by Paramedics: A Case Series. Prehosp Emerg Care. 2024 Mar 15:1-9. doi: 10.1080/10903127.2024.2321287. Epub ahead of print. PMID: 38407212.



1 Comment


Since we're talking about pacing, should we not also be talking about dromotropic agents? Pushing calcium was mentioned, but consider how many of our cardiac patients are on beta blockers. To get the most out of that calcium, maybe glucagon is warranted. I wouldn't care if they were currently eu- or hyperglycemic (<250 would likely be my threshold), since perfusion is the priority with not throwing a clot being a close second.


As for pacing/monitor transfers, that's a good discussion and definitely worth diving into further.

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