Crash Cart 04: Transcutaneous Pacing (TCP)

Transcutaneous Pacing (TCP):
is a temporary means of pacing a patient’s heart during an emergency and stabilizing the patient until a more permanent means of pacing is achieved.

It is accomplished by delivering pulses of electric current through the patient’s chest, stimulating the heart to contract. The most common indication for TCP is symptomatic bradycardia, most commonly resulting from acute MI, sinus node dysfunction, and complete heart block. During TCP, pads are placed on the patient’s chest either in anterolateral position or anterior-posterior (AP) position.

The AP position is preferred because it minimizes transthoracic electrical impedance by sandwiching the heart between the two pads. Current is applied until electrical capture (characterized by a wide QRS complex since the SA node-AV node conducting pathway is bypassed, with tall, broad T-waves on the EKG) occurs. In addition to synchronized TCP, there is an option for asynchronous TCP in cases of VF, VT, complete heart block. Overdrive pacing is used to stop symptomatic tachydysrhythmias.

Finally, do not be fooled by the monitor into believing that the appearance of QRS complexes means that the patient’s heart has been captured and is delivering a sustainable blood pressure! You need to have some way to tell that the heart is being paced and generating a blood pressure; have a pulse oximeter or arterial line waveform for confirmation of the monitor’s electrical activity.

transcutaneous pacing steps
transcutaneous pacing indications
transcutaneous pacing pads