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CARDIOVASCULAR ANESTHESIA

Safe and Efficient Emergency Transvenous Ventricular Pacing via the Right Supraclavicular Route

Klaus Laczika, MD^*, Florian Thalhammer, MD^*, Gottfried Locker, MD^*, Robert Apsner, MD, Heidrun Losert, MD^*, Julia Kofler, MD^*, Werner Rabitsch, MD^*, Peter Mares, MD, Michael Frass, MD^*, Gere Sunder-Plassmann, MD, and Manfred Muhm, MD^*,,

Departments of *Internal Medicine I, Division of Intensive Care, Internal Medicine III, Division of Nephrology and Dialysis, and Cardiothoracic/Vascular Anesthesia & Intensive Care, Vienna University Hospital, Vienna, Austria

Address correspondence reprint requests to Dr. Klaus Laczika, Department of Internal Medicine I, Intensive Care Unit, Vienna University Hospital, Waehringer Guertel 18-20, A-1090 Vienna, Austria. Address e-mail to Klaus.Laczika{at}akh-wien.ac.at

Infraclavicular and internal jugular central venous access are techniques commonly used for temporary transvenous pacing. However, the procedure still has a considerable complication rate, with a high risk/benefit ratio because of insertion difficulties and pacemaker malfunction. To enlarge the spectrum of alternative access sites, we prospectively evaluated the right supraclavicular route to the subclavian/innominate vein for emergency ventricular pacing with a transvenous flow-directed pacemaker as a bedside procedure. For 19 mo, 17 consecutive patients with symptomatic bradycardia, cardiac arrest, or torsade de pointes requiring immediate bedside transvenous pacing were enrolled in the study. The success rate, insertional complications, pacemaker performance, and patients’ outcomes were recorded. Supraclavicular venipuncture was successful in all patients, in 16 of 17 at the first attempt. Adequate ventricular pacing was achieved within 1 to 5 min (median, 2 min) after venipuncture and within 10 s to 4 min (median, 30 s) after lead insertion (30 s in 15 of 17 patients). The median pacing threshold was 1 mA (range, 0.7 to 2.5 mA). No procedure-related complications were recorded. Throughout the pacing period of 1538 h (median: 62 h, range, 1–280 h) two reversible malfunctions caused by inadvertent lead dislodgement after 122 and 171 h were recorded; in one patient the pacemaker had to be removed because of local infection after 14 days of pacing. We conclude that the right supraclavicular route is an easy, safe, and effective first approach for transvenous ventricular pacing and might provide a useful alternative to traditional puncture sites, even in a preclinical setting.

Implications: Temporary transvenous cardiac pacing can yield high complication rates especially under emergency conditions. We investigated emergency pacing via the right supraclavicular access in 17 consecutive hemodynamically compromised patients and found good safety, efficacy, and a low complication rate.

This article has been cited by other articles:

				R. L. Bush, P. H. Lin, C. C. Bianco, J. E. Hurt, T. I. Lawhorn, and A. B. Lumsden Reevaluation of Temporary Transvenous Cardiac Pacemaker Usage During Carotid Angioplasty and Stenting: A Safe and Valuable Adjunct Vascular and Endovascular Surgery, May 1, 2004; 38(3): 229 - 235. [Abstract] [PDF]

				Supraclavicular Route for Emergency Transvenous Pacing Journal Watch Emergency Medicine, July 5, 2000; 2000(705): 6 - 6. [Full Text]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999