Radiologic assessment of transvenous pacemaker placement during CPR

Annals of Emergency Medicine
S A SyverudM L Hanslits

Abstract

During an 18-month period we prospectively studied 36 emergency department patients who had a transvenous pacing catheter placed without fluoroscopic or ECG guidance during closed-chest massage. Transvenous pacing was instituted at a mean elapsed time of 35 minutes (range, ten to 80 minute) after the onset of cardiac arrest, including prehospital and ED care times. Catheter tip position was assessed using postresuscitation or postmortem chest radiographs. Pacing catheters were fixed in the position of electrical capture prior to radiographs; when capture was never achieved, the catheter was fixed at 35 cm from the point of insertion. Position of the catheter tip on radiographs was as follows: right ventricle, ten of 36 patients; right atrium, 18 of 36; and other location, eight of 36. Ectopic catheter tip positions included inferior vena cava (four), pulmonary artery (one), hepatic vein (two), and internal jugular vein (one). Catheter tip position within the right ventricle correlated with a significantly higher incidence of electrical capture when compared with other catheter tip locations (P less than .004). There was a significantly higher incidence of successful placement into the right ventricle when an internal jugular, r...Continue Reading

References

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Citations

Aug 1, 1995·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·J S HuffM A Tucci
Mar 1, 1993·The American Journal of Emergency Medicine·R B Vukmir
Mar 16, 2017·Emergency Medicine Australasia : EMA·Vinay Gangathimmaiah

Related Concepts

Cardiac Pacing, Artificial
Electrocardiographic Recorders
Cardiac Arrest
Cardiac Catheterization Procedures
Resuscitation Procedure
Radiography, Thoracic
Inferior Vena Cava Structure

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