Emergency Cardiac Pacing

Emergency transvenous cardiac pacing

“…The dysrhythmias are commonly caused by myocardial ischaemia/infarction, cardio‐active drug side‐effects or toxicity (beta‐blockers, calcium channel blockers, digoxin) or failure of permanent pacemaker. Rare causes include myocarditis and infiltrative disorders (amyloidosis, sarcoidosis) . The procedure is contraindicated in the presence of prosthetic tricuspid valve and severe hypothermia …”

“…Rare causes include myocarditis and infiltrative disorders (amyloidosis, sarcoidosis) . The procedure is contraindicated in the presence of prosthetic tricuspid valve and severe hypothermia …”

“… Ongoing management of bradycardia with chronotropic drugs and transcutaneous pacing in an area with continuous non‐invasive monitoring. Selection of appropriate team consisting of at least two members: one skilled doctor to perform the procedure and one skilled nurse to monitor patient and assist the doctor. Selection and preparation of appropriate equipment: ○ The pacing catheter (Figs ,): This is a 5‐Fr, 100 cm long, bipolar, flexible, balloon‐flotation catheter with 10 cm markings allowing estimation of the depth of insertion. It has a balloon at one end and a syringe port with a stop cock as well as positive and negative electrodes at the other.…”

“…TVCP catheter insertion is best performed under ultrasound guidance, which has been shown to increase the safety and success rate of the procedure as well as shorten procedural time . The sub‐xiphoid view with a phased‐array probe is preferred due to excellent views of all four cardiac chambers and non‐interference with transcutaneous pacing pads and ECG leads . TVCP catheters can also be inserted without ultrasound guidance using the tracing on cardiac monitor alone as a guide to catheter placement (‘blind technique’) or using ECG guidance.…”

“…The ultrasound‐guided technique is described below. The procedure can be conceptualised in five sequential steps that need to be performed maintaining strict asepsis Insertion of the introducer sheath: This step is similar to the Seldinger's technique of insertion of a central venous catheter with ultrasound guidance.…”