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.

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.
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.

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.

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.