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A Comparative Study of Five Transcutaneous Pacing Devices in Unanesthetized Human Volunteers

  • Michael B. Heller (a1), Joseph Peterson (a2), Keveh Ilkahpamipour (a2), Richard Kaplan (a3) and Paul M. Paris (a4)...

Extract

Transcutaneous Pacing (TCP) is a rapidly applied “non-invasive” technique that can be used successfully in the hospital, emergency department or field setting (1–9). Although the technique has been studied for three decades (7), it is only in the last few years that commercial units have been widely available. Improvements in pad design (particularly the development of non-metallic electrodes) and pulse characteristics (a pulse width of greater than 20 msec.) have allowed the development of units which may provide high capture rates with a level of discomfort which is tolerable in the conscious patient. Transcutaneous pacing may obviate the need for emergency transvenous pacing; further, it is easily adaptable to the field setting although early application appears to be needed for success (1,2).

No study has compared the relative effectiveness of different TCP units, and there are no published data on some of the devices. The purpose of this investigation was to compare the functions of five different external pacemaker units on ten volunteers, in order to determine: 1) what percent of subjects could be captured within the limits of tolerability (the capture rate); 2) how much current was required by each unit to capture (the capture threshold); and 3) the degree of discomfort produced by each pacemaker at the capture threshold.

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University of Pittsburgh, 230 McKee Place, Suite 500, Pittsburgh, PA 15213

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Presented at UAEMS Philadelphia, pa. 1987

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References

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1. O'Toole, KS, Paris, PM, Heller, MB: Emergency Transcutaneous pacing in the management of patients with bradyasystolic rhythms. J Emerg Med 1987; 5:267273.
2. Paris, PM, Stewart, RD, Kaplan, RM, et al. : Transcutaneous pacing for bradyasystolic cardiac arrests in prehospital care. Ann Emerg Med 1985; 14:320323
3. Dalsey, WC, Syverud, SA, Hedges, JR: Emergency department use of transcutaneous pacing for cardiac arrests. Crit Care Med 1985; 13:399401.
4. Berliner, DB, Okun, M, Peters, RW, Carliner, NH, et al. : Transcutaneous temporary pacing in the operating room. JAMA 1985; 254(1):8486.
5. McNeil, EL: Successful resuscitation using external cardiac pacing. Ann Emerg Med 1985; 14:12301232.
6. Clinton, JE, et al. : Emergency noninvasive external cardiac pacing. J Emerg Med 1985; 2:155162.
7. Zoll, PM: Resuscitation of the heart in ventricular standstill by external electrical stimulation. N Engl J Med 1952; 247:768.
8. Falk, RH, Zoll, PM, Zoll, RH: Safety and efficacy of noninvasive cardiac pacing. New Engl J Med 1983; 309:11661170.
9. Zoll, FM, Zoll, RH, Falk, RH, et al. : External noninvasive temporary cardiac pacing: Clinical trials. Circulation 1985; 71:937944.
10. Ohnaus, EE, Adler, R: Methodological problems in the measurement of pain: a comparison between the verbal rating scale and the visual analog scale. Pain 1975; 379384.
11. Kaplan, RM, Heller, MB, Paris, PM, et al. : The effect of different combinations of external pacemakers on pacing threshholds, capture rate, and patient tolerance. Ann Emerg Med (Abstract) 1988; 17:750.
12. Heller, MB: Of pacing, patents and patients. Editorial. J Emerg Med 1988; 6:7879.
13. Walls, RM: Prehospital pacemakers: are they playing our tune? Editorial. J Emerg Med 1987; 5:337338.

A Comparative Study of Five Transcutaneous Pacing Devices in Unanesthetized Human Volunteers

  • Michael B. Heller (a1), Joseph Peterson (a2), Keveh Ilkahpamipour (a2), Richard Kaplan (a3) and Paul M. Paris (a4)...

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