Re-usage of external pacing electrodes results in skin burns.

A 29 year old woman with a background of poorly controlled iabetes was admitted to our hospital in cardiogenic shock due o acute inferior myocardial infarction and complete heart block. ecycled external electrodes (“stat.padz®”) were placed to the right f the upper sternal border below the clavicle and to the left of he nipple with the centre of the electrode in the mid-axillary line. xternal pacing was commenced with an output of 90 mA at a rate f 70 stimulations per minute. Mechanical capture was confirmed y echocardiography. Primary percutaneous coronary intervention o the right coronary artery was performed with insertion of a ransvenous temporary pacemaker. The patient developed intrarocedurally ventricular fibrillation for which a shock of 200 J was elivered through the external electrodes. The total duration of xternal pacing was about 90 min. Upon removal of the external lectrodes, multiple 2nd degree circular skin burns were noticed elow the apical electrode with burnt and necrotic skin flakes dherent to the electrode (Panel A). No burn was observed in the rea of the right sided electrode (see Fig. 1). Many of our patients do not have medical insurance nor are they ble to pay their hospital bills. The price for a set of external pacing lectrodes is about 50 USD in our setting. Every patient requiring ife-saving treatment will be treated regardless of insurance status. his policy however results frequently in the hospital not recoverng cost for consumable products like pacing electrodes. In an effort o reduce cost, external electrodes are re-used – despite the manfacturer’s advice. The gel of re-used electrodes is often dried out ith pockets of gel missing in addition to general contamination nd cracks (Panel B). We assume that the relatively severe burns