After starting transcutaneous pacing, what should be confirmed?

• A. Check waveform.
• B. Assess oxygen saturation.
• C. Confirm electrical capture.
• D. Confirm mechanical capture.

Answer: (D)

The key idea is the difference between electrical capture and mechanical capture in pacing. When you start transcutaneous pacing, you want the impulse not only to depolarize the heart (electrical capture) but to produce an actual heartbeat that moves blood (mechanical capture). It’s possible to see paced beats on the ECG (electrical capture) without the heart adequately contracting, especially in a poorly perfused or injured heart. Therefore, the most important check after initiating pacing is to confirm mechanical capture by assessing for a palpable pulse and a corresponding blood pressure or arterial waveform, showing that perfusion is being restored. If there’s electrical activity without a pulse, you’d optimize pacing settings or pad position to try to achieve a real contraction, and consider escalation (e.g., transvenous pacing) if mechanical capture remains absent. While monitoring the ECG waveform and oxygen saturation are useful, they don’t by themselves prove that the patient is being hemodynamically supported.