PEA is defined as any heart rhythm that is organized, but not accompanied by any palpable pulse. Survival in out-of-hospital cardiac arrests with initial asystole of pulseless electrical activity and subsequent shockable rhythms. Virkkunen I, Paasio L, Ryynanen S, et al. these conditions early and treat them quickly. Pseudo-PEA is a profound state of cardiogenic shock that is inadequate to maintain perfusion pressure (and thus a nondetectable pulse).11 Pseudo-PEA has the presence of aortic pulse pressures with a perfusion pressure less than 60 mm Hg.14 In pseudo-PEA, cardiac electrical activity is present with myocardial contractions that are not adequate to produce a palpable pulse.11 Pseudo-PEA is a form of severe shock in which diminished coronary perfusion leads to decreased myocardial function, thus further propagating hypotension.14 The pathologic insult causing the pseudo-PEA impedes the cardiovascular system’s ability to provide circulation throughout the body.11 In the spectrum of PEA etiologies, pseudo-PEA is frequently caused by hypovolemia, tachydysrhythmias, decreased cardiac contractility, or obstructions to circulation, such as pulmonary embolism, tamponade, and tension pneumothorax.4 Pseudo-PEA rhythms are often narrow QRS complex tachycardias.11, True PEA represents a more severe pathophysiology in which there is a complete absence of mechanical contractions—a true uncoupling of cardiac mechanical activity from the cardiac rhythm.11 Unlike the reduced aortic pressures of pseudo-PEA, true PEA is characterized by the absence of any aortic pulse pressures.11 True PED is characterized by profoundly slow rhythms with wide QRS complexes.11 The electrical component is characterized by an abnormal automaticity, usually seen at a slow ventricular rate with a wide QRS complex (QRS >0.12 seconds).11 Etiologies frequently associated with true PEA include large myocardial infarction, multiorgan failure, profound metabolic imbalances such as hyperkalemia, drug overdoses, hypothermia, acidosis, and prolonged cardiac arrest.11. PEA is one of many waveforms by ECG (including sinus rhythm) without a detectable pulse. When the monitor is attached, you will see a rhythm on the monitor. The absence of a pulse confirms a clinical diagnosis of cardiac arrest. Please note that our company typically implements new training guidelines up to a year before AHA releases their updates. Look for: a history of trauma or severe dehydration, flat jugular veins, and ECG is rapid with narrow ORS complexes. Hallstrom A, Rea TD, Sayre MR, et al. Advanced Cardiac Life Support (ACLS) Certification Course, Ventricular Fibrillation and Pulseless Ventricular Tachycardia, Adult Immediate Post Cardiac Arrest Care Algorithm. Asystole is a flat-line ECG (Figure 27) . Warning: One important takeaway is this: Unless you can quickly identify and treat the cause of PEA, the rhythm will likely deteriorate to asystole. Pulseless electrical activity (PEA) and asystole are related cardiac rhythms in that they are both life-threatening and unshockable. And that’s the root of this next segment goal is to identify and treat the underlying. Treat the possible causes as you work through H’s and T’s. Subsequent research showed that vasopressin offered no benefit over standard-dose epinephrine. The window will refresh momentarily. However, pulses are not palpable. Abrams HC, McNally B, Ong M, Moyer PH, Dyer KS. Compressors should be switched every 2 minutes to ensure efficacy of compressions It's important to find out the potential cause, correct it, and hopefully get a pulse back for that patient. You know, one of my more memorable calls in As healthcare providers, you should memorize the list of common causes to keep from overlooking an obvious cause of PEA that might be reversed by appropriate treatment. Thomas AJ, Newgard CD, Fu R, Zive DM, Daya MR. In PEA, the heart’s electrical activity is present, but the heart muscle is not responding to the […] The most common causes of cardiac arrest are presented as H's and T's as indicated below. The electrical activity is dissociated from the mechanical heart function. The ECG interpretation can appear the same as a normal sinus rhythm. Often, a standardized treatment algorithm is deployed that is the same for each patient in PEA regardless of the etiology, particularly in the prehospital setting, due to the time-critical nature of the disease and lack of a clear identifiable etiology during resuscitation12. Your preference has been saved. Give 10 breaths per minute and check rhythm every 2 minutes. Respiratory Arrest Case Teaching (01:45), What is Acute Coronary Syndrome? The window will refresh momentarily. H’s and T’s as underlying causes for PEA. Privacy | If left untreated, the electrical activity will eventually stop, and the patient will then be in asystole. Navarro S. Advanced cardiovascular life support provider manual. Stop CPR only when absolutely necessary for pulse and rhythm checks. And therefore in PEA, it’s important to Pulsations can be detected by an arterial waveform or Doppler study. Engdahl J, Bang A, Lindqvist J, Herlitz J. They can also check for heart sounds by using a stethoscope for no more than 10 seconds. Look for: a history of recent exposure to cold environment and low core body temperature. Characteristics of the PEA arrest rhythm may help with determining who would benefit from aggressive postcardiac care interventions such as therapeutic hypothermia.2,8,18,9, Even though most providers define PEA as an electrical rhythm with absent mechanical activity, Mehta further delineated PEA into pseudo-PEA and true PEA. or in other words, acidosis, hypo and hyperkalemia, The T’s are tension pneumothorax, cardiac All pulseless rhythms that fall outside the category of pulseless ventricular tachycardia, ventricular …