Pulseless electrical activity

Pulseless Electrical Activity (PEA)

Introduction

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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Source: Data courtesy of the U.S. National Library of Medicine. Since the data might have changed, please query MeSH on Pulseless electrical activity for any updates.

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