Transcutaneous pacing should be considered in pediatric arrest under which condition?

• A. During any pediatric arrest regardless of rhythm
• B. For tachyarrhythmias only after shock delivery
• C. In severe symptomatic bradycardia unresponsive to atropine or when pacing is necessary to restore heart rate
• D. For routine transport only

Answer: (C)

Transcutaneous pacing is used in pediatric arrest when there is severe symptomatic bradycardia that does not respond to atropine or when pacing is needed to raise and maintain the heart rate. In children, bradycardia with poor perfusion is a common arrest scenario, and while atropine is a first-line treatment, it may not work for all patients. When the heart rate remains too slow and perfusion stays compromised, transcutaneous pacing provides a rapid electrical stimulus to improve cardiac output as a bridge to more definitive pacing or treatment of the underlying cause. It’s not the default measure for all arrests or for routine transport, and tachyarrhythmias are typically addressed with defibrillation or cardioversion rather than pacing unless a bradycardic component from block is present.