Transcutaneous Pacing


  • temporary cardiac pacing using pads or paddles applied externally to the chest


  • bradycardia unresponsive to drug therapy
  • 3rd degree heart block
  • Mobitz type II second-degree heart block when haemodynamically unstable or operation planned
  • overdrive pacing
  • asystole


  • place pads in AP position (black on anterior chest, red on posterior chest)
  • connect ECG leads
  • set pacemaker to demand
  • turn pacing rate to > 30bpm above patients intrinsic rhythm
  • set mA to 70
  • start pacing and increase mA until pacing rate captured on monitor
  • if pacing rate not captured at a current of 120-130mA -> resite electrodes and repeat the above.
  • once pacing captured, set current at 5-10mA above threshold


  • failure to pace and failure to capture
  • discomfort


Jason Nomura (2013) on the practical aspects of emergent pacing:

CCC 700 6

Critical Care


Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of three amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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