FIELD REFERENCE
Full criteria & treatment guidance
Capture must be electrical and mechanical
- Do not use TCP for asystole or PEA cardiac arrest, and do not withhold chest compressions to attempt pacing in asystole.
- When TCP is indicated, do not delay or interrupt it to obtain a 12-lead ECG.
- Use palpable pulses and perfusion findings to verify mechanical capture; monitor pacing spikes alone are not enough.
- Medication and base-contact steps differ between adult and pediatric bradycardia pathways; use the corresponding standing order with this procedure.
Confirm symptomatic bradycardia
- Use TCP for temporary management of symptomatic bradycardia, including heart blocks. PR-110 includes adults/adolescents and children with a heart rate below 60/min.
- Poor perfusion related to the bradycardia may appear as adult systolic BP below 90 mm Hg, pediatric systolic BP below 80 mm Hg, dyspnea, acute altered consciousness, chest pain of suspected cardiac origin, or poor-perfusion skin signs.
- Follow the applicable adult or pediatric bradycardia standing order for oxygenation, ventilation, medication, and base-contact requirements. Do not delay urgently needed pacing for vascular access.
- Adult/adolescent pathway (SO-C-020): if IV/IO access cannot be obtained or the initial atropine dose does not improve the heart rate, proceed to pacing as directed by the standing order. Once paced, stop atropine and contact base for potential CVRC destination. Follow the full order for medication and perfusion management.
- Pediatric pathway (SO-P-045): support oxygenation and ventilation first. If the pulse remains below 60/min with continued poor perfusion despite oxygenation/ventilation, initiate CPR, establish IV/IO access, administer epinephrine under the pediatric order, and contact base (CCERC base preferred). The order provides conditional atropine guidance if base contact cannot be made. For continued poor perfusion, obtain a base-hospital order before TCP; do not substitute the adult escalation or sedation regimen.
Place pads & start pacing
- Explain the procedure to the patient, family member, or caregiver when circumstances allow. Use the manufacturer-directed equipment and appropriate-size pads.
- Place pacing pads in the anterior-posterior chest and back position and attach the pacing cables. SO-P-045 specifies appropriately sized pediatric pads with preferred anterior-posterior placement unless the child is adult size; follow the applicable procedure and device instructions.
- Activate the pacing module. Set the initial rate to 70/min and current to 0 mA.
- Slowly increase current until both electrical and mechanical capture are present. PR-110 caps current at 120 mA.
Verify capture & relieve symptoms
- Confirm electrical capture on the monitor and mechanical capture with palpable pulses that correspond to pacing spikes. Do not call monitor capture alone successful pacing.
- After capture, slowly increase the paced rate only if needed to relieve bradycardia symptoms; PR-110 caps the paced rate at 100/min.
- If capture is not achieved, continue oxygen and the applicable medication pathway. Repeated capture attempts may follow medication and oxygen administration.
Discomfort, monitoring & documentation
- If pacing discomfort is not tolerated and systolic BP is above 90, follow PR-110 and the applicable standing order for sedation. Adult/adolescent options listed in PR-110 are midazolam 5 mg IV once, or 5 mg IN with one repeat after about 3 minutes if needed.
- A child 13 months to under 15 years who needs additional sedation during transport requires base-hospital contact for further orders.
- Document placement time, whether capture and pacing occurred, the rate and current used to obtain capture, and the response in BP, perfusion, and mental status.
VISUAL FIELD REFERENCE
Pacing: electrical capture + mechanical capture
Adult & pediatric · ALS
Verify BOTH. Continue assessment of blood pressure, perfusion, and symptoms.
BOTH types of capture are required (AND)
Electrical capture
Confirm electrical capture on the monitor
Mechanical capture
mechanical capture with palpable pulses that correspond to pacing spikes.
- Do not use TCP for asystole or PEA cardiac arrest, and do not withhold chest compressions to attempt pacing in asystole.
- Do not call monitor capture alone successful pacing.
Selected checkpoints; read the complete guide for criteria, exclusions, doses, and ongoing care. PR-110
UNDERSTAND THE CARE
Why pacing spikes are only the beginning of confirmation
Electrical capture is a monitor observation; mechanical capture requires evidence of circulation corresponding to the paced activity. Assess palpable pulses and perfusion alongside the tracing. A display showing spikes at the selected rate does not establish successful circulatory support.
Applying the guidance
After capture, continue monitoring pressure, consciousness and symptoms and use the procedure’s limits for current and rate. Discomfort management retains its own blood-pressure, age and base-contact conditions. Document the settings needed for capture and the patient response so the receiving team understands both the electrical and clinical result.
Electrical and mechanical capture
Putting it together
Teaching example: pacing spikes are present but there is no corresponding palpable pulse. Continue assessing capture and follow the applicable escalation instructions; do not record mechanical capture solely from the monitor.
Diagram text & teaching checkpoints
- Indication
- Symptomatic bradycardia, not PEA/asystole.
- Electrical capture
- Assess the paced rhythm.
- Mechanical capture
- Confirm corresponding pulses and perfusion.
- Continuing care
- Settings, comfort and repeated assessment.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.
Hand off capture, settings and the patient together
Describe the evidence for capture rather than only reporting that the pacer is on. Include the electrical finding, the corresponding palpable pulse and the effect on blood pressure, consciousness and symptoms. These observations answer different questions; a selected rate and a displayed spike count are device settings, not a complete patient assessment.
Keep a record of the current and rate used to obtain capture and the settings at transfer. During movement and handoff, the receiving clinician needs to know whether capture remains present, whether perfusion improved, and what discomfort treatment was given. If capture was intermittent or could not be achieved, state that clearly instead of letting the last monitor screenshot imply a continuous successful result.
For training, compare two reports: “paced at the selected rate” versus “electrical capture with matching palpable pulses, followed by the observed pressure and mental-status response.” The second gives actionable evidence. Continue the applicable adult or pediatric bradycardia order; pacing controls, medication sequence, sedation restrictions and base requirements must all describe the same patient.