Pulseless electrical activity

Pulseless electrical activity
Other namesElectromechanical dissociation
A drawing of what a rhythm strip showing PEA could look like
SpecialtyCardiology Edit this on Wikidata

Pulseless electrical activity (PEA) is a form of cardiac arrest in which the electrocardiogram shows a heart rhythm that should produce a pulse, but does not. Pulseless electrical activity is found initially in about 20% of out-of-hospital cardiac arrests[1] and about 50% of in-hospital cardiac arrests.[2]

Under normal circumstances, electrical activation of muscle cells precedes mechanical contraction of the heart (known as electromechanical coupling). In PEA, there is electrical activity but insufficient cardiac output to generate a pulse and supply blood to the organs, whether the heart itself is failing to contract or otherwise.[3] While PEA is classified as a form of cardiac arrest, significant cardiac output may still be present, which may be determined and best visualized by bedside ultrasound (echocardiography).

Cardiopulmonary resuscitation (CPR) is the first treatment for PEA, while potential underlying causes are identified and treated. The medication epinephrine (aka adrenaline) may be administered.[3] Survival is about 20% if the event occurred while the patient was already in the hospital setting.[4]

  1. ^ Bergström, Mattias; Schmidbauer, Simon; Herlitz, Johan; Rawshani, Araz; Friberg, Hans (December 2018). "Pulseless electrical activity is associated with improved survival in out-of-hospital cardiac arrest with initial non-shockable rhythm". Resuscitation. 133: 147–152. doi:10.1016/j.resuscitation.2018.10.018. ISSN 1873-1570. PMID 30352246. S2CID 53025153.
  2. ^ Norvik, A.; Unneland, E.; Bergum, D.; Buckler, D. G.; Bhardwaj, A.; Eftestøl, T.; Aramendi, E.; Nordseth, T.; Abella, B. S.; Kvaløy, J. T.; Skogvoll, E. (2022-07-01). "Pulseless electrical activity in in-hospital cardiac arrest – A crossroad for decisions". Resuscitation. 176: 117–124. doi:10.1016/j.resuscitation.2022.04.024. hdl:10810/57896. ISSN 0300-9572. PMID 35490937.
  3. ^ a b Cite error: The named reference 2010AHA was invoked but never defined (see the help page).
  4. ^ Baldzizhar, A; Manuylova, E; Marchenko, R; Kryvalap, Y; Carey, MG (September 2016). "Ventricular Tachycardias: Characteristics and Management". Critical Care Nursing Clinics of North America. 28 (3): 317–29. doi:10.1016/j.cnc.2016.04.004. PMID 27484660.