Question of the Week

You are caring for a patient in cardiac arrest and are inserting a transvenous pacemaker in the ED.  Do you inflate the balloon?


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13 Responses

  1. Adam,
    A lesser physician may inflate the balloon, but it offers not benefit as there is not forward venous flow to help guide the tip into the right ventricle. If anything it would impede both venous flow and cardiac return and migration of the balloon into the right ventricle.


    The Journal of Emergency Medicine, Volume 32, Issue 1, Pages 105-111 (January 2007)

  2. No, unless you are simultaneously doing chest compressions, because there would be no blood flow to carry the balloon.

    But why are you floating a pacer in a dead guy anyway??

  3. 1.) In the face of Cardiac Arrest inflating the balloon carries no benefit. Therefore, the answer is NO, you do not inflate the balloon. With usual indications for TPV, yes, you inflate the balloon until you get into the correct spot (right ventricle). That’s why it is called “floating a pacer”. Usually, the balloon is inflated once the catheter is in about 10 cm. Forgetting to inflate the balloon is a pitfall and can lead to misplacement and damage to the ventricle. To get specific you should inflate the balloon twice (the first time being to make sure it is functioning properly).

  4. The balloon has less of a guidance function with no pulse, though CPR does generate some flow, and likely preserves some guidance function.

    Inflation of the balloon also has a protective function, i.e. preventing myocardial puncture. This is likely the most important reason to inflate the balloon in a cardiac arrest situation.

    so yes….inflate the balloon.

  5. NO
    the patient does not have cardiac activity, inflating the balloon is not going to help

  6. Yes, but make sure the pacer wire is inserted past the length of the cordis sheath first.

  7. Yes, inflate the balloon in order to float it into the ventricle.

  8. yes

  9. Yes

  10. No, the balloon should only be inflated to allow for “floating” of the transvenous pacemaker into the ventricle if the heart is actively pumping blood.

  11. no

  12. No

  13. Weber’s syndrome (superior alternating hemiplegia)
    PCA stroke

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