Pediatric Advance Life Support: Unstable Bradycardia

Transcutaneous Pacing

·         May be helpful in children with bradycardia associated with congenital heart  disease or acquired heart disease

·         Not helpful with bradycardia related to post arrest hypoxia or ischemia myocardial insult or respiratory arrest

Note:  Emergency transcutaneous pacing may be lifesaving if the bradycardia is due to complete heart block or sinus node dysfunction unresponsive to ventilation, oxygenation, chest compressions, and medications, especially if it is associated with congenital or acquired heart disease.

Transcutaneous Pacing

·         Pediatric pads are recommended for children weighing less than 10 kg

·         Adult pads may be used on children weighing over 10kg

·         Use anterior/posterior placement or apex/anterior position

·         Do not place over ICD or pacemaker devices

Note:  Use the largest self-adhering electrodes that will fit on the child’s chest without touching (when possible, leave about 3 cm between the paddles or electrodes)

Transcutaneous Pacing

·         Set rate at 100 bpm

·         Set output at maximum and adjust downward to slightly above point where capture is achieved

·         Ventricular capture is observed when a QRS complex follows a pacer spike

·         Mechanical capture is determined by palpating a pulse

Transcutaneous Pacing

Transcutaneous Pacing

·         May be painful so consider analgesics or sedation

·         Morphine

·         Versed

·         Ativan

·         Reassess rhythm frequently