ABSTRACTS
Frequency and Dangers of False Capture in the Prehospital Setting: A Case SeriesAuthor: Joshua Kimbrell, NRP, FP-C | | Associate Authors: Dana Poke, EMT, Mikiel Lala, EMT-P, Brittany Kalosza, EMT-P, Jacob Geldner, EMT-P, Tom Bouthillet, NRP, John Vega, MD
Introduction Transcutaneous pacing (TCP) is an electrical procedure that was pioneered 1952 and is reserved for critically ill bradycardic patients. Often used as an adjunct to atropine and chronotropic vasopressor agents, TCP is an effort to correct a profound bradycardia with hemodynamic collapse. Existing research does not adequately detail the frequency of unrecognized failure to pace, and the American Hospital Association (AHA) lists TCP as a Class 2b recommendation. This case series describes the frequency and impact of failed TCP in prehospital care. Objective To describe the frequency and impact of failed TCP in prehospital care. Methods This was a retrospective chart review of all patients in an urban hospital-based EMS system with TCP performed between March 2021 and March 2023. Inclusion criteria were adults with unstable bradycardia and attempted TCP. There were no exclusion criteria. Primary outcome was whether pacing was conducted electrically, defined as a discernible QRS with a visible T wave. Secondary outcomes include blood pressure changes and neurological status at discharge. Results All 23 patients had a documented palpated pulse in the electronic patient care record, but only 17% had electrical capture upon review. Of those with electrical capture, the median change in SBP was +40 mm Hg (−12 to 49 mm Hg). Of those without, the median change in SBP was −1 mm Hg (−90 to 23 mm Hg). The median current for patients with capture was 95 mA (85 to 110 mA) and the median current for those without capture was 70 mA (55 to 160 mA). Of the sample, 73.9% had hospital outcome data available. From this group, one of two patients with electrical capture survived to discharge with a good functional capacity, and both survived to admission. Of those without electrical capture, none had neurologically intact survival, and 67% survived to admission. Conclusion The cases reveal how TCP can pose a challenge to prehospital clinicians, with worsening blood pressure trends and survivability in the patients without electrical capture upon review. This case series suggests that training in TCP may be inadequate and that pulse checks may be an unreliable indicator of mechanical capture. Further research should investigate the efficacy of TCP by paramedics and effective strategies to reduce incidences of false capture.
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