Pulseless electrical activity

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Pulseless electrical activity
Synonyms	Electromechanical dissociation
Pronounce	N/A
Specialty	N/A
Symptoms	Unconsciousness, absence of pulse, no breathing
Complications	Cardiac arrest, death
Onset	Sudden
Duration	Until treated
Types	N/A
Causes	Hypoxia, hypovolemia, hypothermia, hyperkalemia, acidosis, tension pneumothorax, cardiac tamponade, pulmonary embolism, myocardial infarction, drug overdose
Risks	Coronary artery disease, heart failure, severe trauma
Diagnosis	Electrocardiogram, absence of pulse
Differential diagnosis	Asystole, ventricular fibrillation, ventricular tachycardia
Prevention	N/A
Treatment	Cardiopulmonary resuscitation, epinephrine, addressing underlying cause
Medication	N/A
Prognosis	Poor without immediate treatment
Frequency	Common in cardiac arrest
Deaths	N/A

Pulseless Electrical Activity (PEA) is an electrocardiographic finding characterized by the presence of cardiac electrical activity without an adequate mechanical response from the myocardial tissue, resulting in no effective cardiac output or palpable pulse. Despite the presence of electrical rhythms on the ECG, the heart fails to pump blood effectively, leading to a critical condition that requires immediate medical intervention.

An example of an ECG showing Pulseless Electrical Activity.

Causes

PEA can be caused by a variety of conditions that can be categorized into hypovolemic, hypoxic, hydrogen ion (acidosis), hyper-/hypokalemia, hypothermia, toxins, tamponade (cardiac), tension pneumothorax, thrombosis (coronary or pulmonary), and trauma (the "H's and T's"). Each of these conditions can lead to the disruption of cardiac function, resulting in PEA.

• Hypovolemia
• Hypoxia
• Acidosis
• Potassium imbalance
• Hypothermia
• Cardiac tamponade
• Tension pneumothorax
• Thrombosis
• Trauma

Diagnosis

The diagnosis of PEA is primarily made through clinical assessment and the use of an Electrocardiogram (ECG) to detect the presence of cardiac electrical activity in the absence of a palpable pulse. It is crucial to differentiate PEA from other forms of cardiac arrest, such as asystole or ventricular fibrillation, to guide appropriate treatment.

Diagram of heart anatomy relevant to understanding PEA.

Treatment

The treatment of PEA focuses on rapid identification and correction of the underlying cause. Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) protocols recommend immediate CPR and possible administration of intravenous fluids, oxygen, and medications like epinephrine, depending on the identified cause.

Prognosis

The prognosis of PEA is generally poor, especially if the underlying cause is not quickly identified and corrected. Survival rates are significantly lower compared to other forms of cardiac arrest, underscoring the importance of prompt and effective resuscitation efforts.

See Also

• Cardiac arrest
• Advanced Cardiac Life Support (ACLS)
• Basic Life Support (BLS)
• Electrocardiogram (ECG)

References

• Advanced Cardiovascular Life Support: Provider Manual. American Heart Association, latest edition.
• European Resuscitation Council Guidelines for Resuscitation. European Resuscitation Council, latest edition.

External Links

• American Heart Association
• Resuscitation Council (UK)
• European Society of Cardiology

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