Prehospital Protocols for Transcutaneous Pacing in the United States A Cross-Sectional Descriptive Analysis
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Abstract
Objectives: Transcutaneous pacing (TCP) has a Class IIb recommendation from the American Heart Association (AHA) for the treatment of hemodynamically unstable bradycardia. Recent studies highlight a high rate of treatment failure and known difficulties verifying electrical capture (“false electrical capture”) and mechanical capture. This study aimed to characterize the current recommendations within US prehospital TCP protocols.
Methods: A convenience sample of 260 prehospital protocols were selected from publicly available resources. Two trained abstractors were assigned to each; pre-specified categorical variables and free-text responses were recorded. The latter were coded using content analysis. Responses were analyzed using descriptive statistics and reported as frequencies and proportions.
Results: 228 protocols completed paired abstraction, 177/228 (78%) were accessible and mentioned TCP. The most frequent indication was symptomatic bradycardia 172/177 (97%). Electrical capture was mentioned in 116/177 (66%) with false electrical capture discussed in only 8/177 (5%). Pulse palpation was the primary method for capture confirmation 123/177 (69%). Indications discordant with AHA guidelines included cardiac arrest 23/177 (13%) and seizures 18/177 (10%). Overall, 70/177 (40%) protocols were assessed to completely match, 65/177 (37%) partially match, and 41/177 (23%) did not match AHA guidelines for TCP.
Conclusions: Prehospital TCP protocol indications varied, with 77% partially or completely matching AHA guidelines for TCP. Nevertheless, guideline-discordant recommendations remained. False electrical capture was rarely mentioned. Further research should systematically assess TCP implementation including methods to assess and confirm capture, and whether guideline adherence in prehospital protocols improves outcomes and reduces TCP failure.
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