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Difference Between Demand vs. Non-Demand Pacing?

Question# 802

If paramedics are transporting a patient who is being successfully paced and are encountering the pacer dropping off due to the ambulance motion and associated artifact do you have any suggestions for ensuring that the pacer remains functional without interruption? My thought was to force the pacer into fixed rather than demand pacing temporarily if this was repeatedly happening but I don't know if there is a better solution

Answer:


As you may recall from the online and in-class learning from Fall 2023 CME as well as the manufacturer guidelines for both LP15 and Zoll X Series regarding pacing:

Your monitor should default to demand pacing (used for most, if not all patients) which will allow it to disable the pacing function if the patient’s intrinsic rate or underlying rhythm beats above the set paced rate.

If the lead size is too small or your patient is too diaphoretic (leads don’t stick or come off) then the monitor will automatically switch to non-demand pacing mode or “fixed rate” meaning, the patient will be paced regardless of their intrinsic rate. This can also be selected manually if there is too much artifact interfering with sensing QRS complexes while transporting the patient. Remember, when pacing a patient you require both the leads (rhythm interpretation) and the pads (deliver electricity) to be in place.

Please note, you should make all attempts to clean, dry, shave the skin, select a different lead, increase lead size, and put on new leads prior to switching the monitor to non-demand pacing, as this comes with risks. For example, causing R-on-T phenomenon resulting in V-fib or V-tach as the monitor paces regardless of intrinsic electrical activity. If all troubleshooting techniques listed above have been attempted and you are still unable to pace the patient appropriately, you may switch modes without a patch and document the reasoning.

You can find this information by logging into MedicLEARN and searching 'symptomatic bradycardia' from Fall 2023 CME and by reading the manufacturer guidelines for your service's defibrillator.

References

Lifepack 15 Manufacturer Guidelines
Zoll X Series Manufacturer Guidelines

Education Links

Fall 2023 CME - Symptomatic Bradycardia

Published

24 April 2024

ALSPCS Version

5.3

Views

1203

Please reference the MOST RECENT ALS PCS for updates and changes to these directives.