Abstract
Background
The standard approach for urgent trans-venous temporary cardiac pacemaker (TVTP) implantation is fluoroscopy guidance. The delay in activation of the fluoroscopy-room and the transfer of unstable patients may be life-threatening. Echocardiography-guided TP implantation may increase the safety of the patients by obviating the need for in-hospital transfer. We examined the feasibility and safety of echocardiography-guided vs. fluoroscopy-guided TVTP implantation.
Methods
From January 2015 to September 2017 data for consecutive patients who needed emergent TVTP implantation were retrospectively reviewed. Ultrasound-guided TVTP protocol that was introduced in our center in January 2015 involved ultrasound guidance for both central venous access and pacing lead positioning. Access sites included femoral, subclavian, or jugular veins. Electrodes were placed in the right ventricular apex by means of echocardiographic monitoring in intensive care unit or by fluoroscopic guidance. Endpoints were achievement of successful ventricular pacing and procedural complications.
Results
Sixty-six patients (17 echocardiography-guided and 49 fluoroscopy-guided) were included. There were no differences in pacing threshold between the echocardiography-guided group and the fluoroscopy-guided group (0.75 ± 0.58 mA vs. 0.57 ± 0.35 mA, p = 0.24). The access site for implantation was femoral vein in 27% for the fluoroscopy-guided vs. none for the echocardiography-guided approach (p = 0.015). One hematoma and one related infection occurred in the fluoroscopy-guided group. The need for electrode repositioning was observed in 1 patient in each group. There were no procedural-related deaths in either group.
Conclusions
Echocardiography-guided temporary cardiac pacing is a feasible and safe alternative to fluoroscopy-guided approach and significantly lowers the need for in-hospital transfer.
Similar content being viewed by others
Abbreviations
- POCUS:
-
Point-of-care ultrasound
- TVTP:
-
Trans-venous temporary cardiac pacemaker
References
Fitzpatrick A, Sutton R. A guide to temporary pacing. BMJ. 1992;304:365–9.
Gammage MD. Temporary cardiac pacing. Heart. 2000;83:715–20.
Gillman L, Leslie G, Williams T, et al. Adverse events experienced while transferring the critically ill patient from the emergency department to the intensive care unit. Emerg Med J. 2006;23:858–61.
Knight PH, Maheshwari N, Hussain J, et al. Complications during intrahospital transport of critically ill patients: focus on risk identification and prevention. Int J Crit Illn Inj Sci. 2015;5:256–64.
Kulshrestha A, Singh J. Inter-hospital and intra-hospital patient transfer: recent concepts. Indian J Anaesth. 2016;60:451–7.
Papson JP, Russell KL, Taylor DM. Unexpected events during the intrahospital transport of critically ill patients. Acad Emerg Med. 2007;14:574–7.
Boyko SM. Interfacility transfer guidelines: an easy reference to help hospitals decide on appropriate vehicles and staffing for transfers. North flight emergency medical services. J Emerg Nurs. 1994;20:18–23.
Esmail R, Banack D, Cummings C, et al. Is your patient ready for transport? Developing an ICU patient transport decision scorecard. Healthc Q. 2006;9:80–6.
Fanara B, Manzon C, Barbot O, et al. Recommendations for the intra-hospital transport of critically ill patients. Crit Care. 2010;14:R87.
Wilson P. Safe patient transportation: nurses can make a difference. Nurs Times. 1998;94:66–7.
Nicolaou S, Talsky A, Khashoggi K, et al. Ultrasound-guided interventional radiology in critical care. Crit Care Med. 2007;35:S186–97.
Ferri LA, Farina A, Lenatti L, et al. Emergent transvenous cardiac pacing using ultrasound guidance: a prospective study versus the standard fluoroscopy-guided procedure. Eur Heart J. 2016;5:125–9.
Neskovic AN, Edvardsen T, Galderisi M, European Association of Cardiovascular Imaging Document Reviewers, Popescu BA, Sicari R, Stefanidis A, et al. Focus cardiac ultrasound: the European Association of Cardiovascular Imaging viewpoint. Eur Heart J Cardiovasc Imaging. 2014;15:956–60.
Lancellotti P, Price S, Edvardsen T, et al. The use of echocardiography in acute cardiovascular care: recommendations of the European Association of Cardiovascular Imaging and the Acute Cardiovascular Care Association. Eur Heart J Acute Cardiovasc Care. 2015;4:3–5.
Price S, Platz E, Cullen L, et al. Expert consensus document: echocardiography and lung ultrasonography for the assessment and management of acute heart failure. Nat Rev Cardiol. 2017;14:427–40.
Durbec O, Viviand X, Potie F, et al. A prospective evaluation of the use of femoral venous catheters in critically ill adults. Crit Care Med. 1997;25:1986–9.
Joynt GM, Kew J, Gomersall CD, et al. Deep venous thrombosis caused by femoral venous catheters in critically ill adult patients. Chest. 2000;117:178–83.
Merrer J, De Jonghe B, Golliot F, et al. French Catheter Study Group in Intensive Care. Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial. JAMA. 2001;286:700–7.
Mian NZ, Bayly R, Schreck DM, et al. Incidence of deep venous thrombosis associated with femoral venous catheterization. Acad Emerg Med. 1997;4:1118–21.
Trottier SJ, Veremakis C, O’Brien J, et al. Femoral deep vein thrombosis associated with central venous catheterization: results from a prospective, randomized trial. Crit Care Med. 1995;23:52–9.
McCann P. A review of temporary cardiac pacing wires. Indian Pacing Electrophysiol J. 2007;7:40–9.
Zieleskiewicz L, Muller L, Lakhal K, et al. Point-of-care ultrasound in intensive care units: assessment of 1073 procedures in a multicentric, prospective, observational study. Intensive Care Med. 2015;41:1638–47.
Funding
This research received no grant from any funding agency in the public, commercial, or not-for-profit sectors.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Author Aref El Nasasra declares that he has no conflict of interest. Author Hilmi Alnsasra declares that he has no conflict of interest. Author Doron Zahger declares that he has no conflict of interest. Author Tsahi T Lerman declares that he has no conflict of interest. Author Sergio Kobal declares that he has no conflict of interest. Author Carlos Cafri declares that he has no conflict of interest. Author Moti Haim declares that he has no conflict of interest. Author Lior Fuchs declares that he has no conflict of interest. Author Avi Shimony declares that he has no conflict of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
The need to obtain an informed consent was waived due to the retrospective nature of the study.
Rights and permissions
About this article
Cite this article
El Nasasra, A., Alnsasra, H., Zahger, D. et al. Feasibility and safety of exclusive echocardiography-guided intravenous temporary pacemaker implantation. J Echocardiogr 17, 157–161 (2019). https://doi.org/10.1007/s12574-018-0406-4
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12574-018-0406-4