Hemodynamic Instability and Resuscitation Common causes of PEA are cardiac tamponade, dynamic lung hyperinflation, tension pneumothorax, and coronary artery graft occlusion or dehiscence. Severe hypovolemia due to blood loss (e.g., into the chest) may also manifest as PEA (Table 20-9).
What are the two most common causes of PEA?
Hypovolemia and hypoxia are the two most common causes of PEA. They are also the most easily reversible and should be at the top of any differential diagnosis. If the individual has a return of spontaneous circulation (ROSC), proceed to post-cardiac arrest care.
What are the common causes of PEA?
What are the most common causes of pulseless electrical activity?
- Blood loss or low blood pressure.
- Low oxygen levels.
- Dehydration or other electrolyte problems.
- Heart attack.
- Pulmonary embolism.
- Irregular heart rhythms (arrhythmias), especially ventricular fibrillation and ventricular tachycardia.
Is there cardiac output in PEA?
PEA is a clinical state characterized by the presence of electrical activity in the absence of detectable cardiac output. This is a preterminal condition that often leads to asystole.
Can hypotension cause PEA?
Pulseless electrical activity, or PEA, can cause cardiac arrest and occurs when any medical disorder causes severe hypotension during which the blood pressure drops critically low to the point where peripheral pulses are not palpable.
What is the most common cause of pulseless electrical activity?
Respiratory failure leading to hypoxia is one of the most common causes of pulseless electrical activity, responsible for about half of the PEA cases.
Which is worse PEA or asystole?
According to International Liaison Committee on Resuscitation (ILCOR), pulseless electrical activity refers to any rhythm that occurs without a detectable pulse; however, it excludes ventricular fibrillation (VF) and ventricular tachycardia (VT). Asystole is the more life-threatening arrhythmia.
How does PEA present on ECG?
Pulseless electrical activity (PEA) refers to 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 55% of people in cardiac arrest.
Can you come back from PEA?
Yes, you or your patient can survive PEA if you eliminate the primary cause of the PEA arrest to return the heart to a shockable rhythm. Then resume actions according to the ACLS cardiac arrest algorithm.
How long can you survive PEA?
Recent studies have shown that 5.8–6.8% of PEA patients are alive 30 days after resuscitation[7, 11]. The long-term outcome of patients resuscitated from PEA is unknown, whereas the long-term outcome of patients with VF as initial rhythm is well documented[12].
Is PEA common in patients with hypovolemia?
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.
Do you shock for PEA?
Rhythms that are not amenable to shock include pulseless electrical activity (PEA) and asystole. In these cases, identifying primary causation, performing good CPR, and administering epinephrine are the only tools you have to resuscitate the patient.
How do you treat PEA in ACLS?
PEA is not a shockable rhythm and treatment for PEA involves high quality CPR, airway management, IV or IO therapy, and appropriate medication therapy. The primary medication is going to be 1mg epinephrine 1:10,000 every 3-5 minutes rapid IV or IO push.
Can you have a blood pressure with PEA?
Pulseless electrical activity is diagnosed based on a patient having an organized, non-shockable rhythm and no palpable pulse. However, PEA is not always a cardiac arrest state. In many cases, patients with PEA have underlying cardiac activity and detectable arterial blood pressure.
Can PEA turn into VF?
Although VF cannot spontaneously develop into PEA, PEA can spontaneously progress to VF, which is associated with substantially decreased survival when compared with survival in those patients with PEA that does not degenerate to VF.
Which conditions can precipitate ventricular fibrillation?
The most common risk factors are:
- A weakened heart muscle (cardiomyopathy)
- An acute or prior heart attack.
- Genetic diseases such as Long or Short QT syndrome, Brugada disease, or hypertrophic cardiomyopathy.
- Certain medicines that affect heart function.
- Electrolyte abnormalities.
Which drug is given first to a patient with pulseless electrical activity?
Epinephrine should be administered in 1-mg doses intravenously/intraosseously (IV/IO) every 3-5 minutes during pulseless electrical activity (PEA) arrest. Higher doses of epinephrine have been studied and show no improvement in survival or neurologic outcomes in most patients.
Can you shock someone with no pulse?
The short answer to this is no. An AED can only be used on someone with a rapid heart rate. You cannot use it on victims with an extremely slow heart rhythm or those whose heart stops beating.
What medication is given for PEA?
When treating PEA, epinephrine can be given as soon as possible but its administration should not delay the initiation or continuation of CPR. High-quality CPR should be administered while giving epinephrine, and after the initial dose, epinephrine is given every 3-5 minutes.
How long can PEA rhythm last?
All patients had stable vital signs at the time of disconnection from the ventilator and progressed through PEA to asystole over 12 to 21 minutes, with time to PEA being around 10 minutes.
Do you give atropine for asystole?
The recommended dose of atropine for cardiac arrest is 1 mg IV, which can be repeated every 3 to 5 minutes (maximum total of 3 doses or 3 mg) if asystole persists (Class Indeterminate).