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.
| Pulseless electrical activity | |
|---|---|
| Specialty | Cardiology |
How can you tell PEA on ECG?
Pulseless electrical activity (PEA) and asystole are related cardiac rhythms in that they are both life-threatening and unshockable cardiac rhythms. Asystole is a flat-line ECG (Figure 27).
Rules for PEA and Asystole.
| PEA Regularity | Any rhythm including a flat line (asystole). |
|---|---|
| P Wave | Possible P wave or none detectable. |
What rhythm can PEA present as?
True PEA is a condition in which cardiac contractions are absent in the presence of coordinated electrical activity. PEA encompasses a number of organized cardiac rhythms, including supraventricular rhythms (sinus versus nonsinus) and ventricular rhythms (accelerated idioventricular or escape).
How would you know your patient is in PEA?
Signs and Symptoms
A patient with PEA will be unconscious with no breathing and no pulse. PEA leads to a loss of cardiac output and discontinues blood supply to the brain. The skin may appear pallor due to no oxygen in the blood. Make sure to check for a pulse at the carotid artery.
Which ECG findings are seen in pulseless ventricular tachycardia?
Electrophysiology identifying factors for pulseless ventricular tachycardia include; tachycardia (>100 bpm), wide QRS complexes (> 120 milliseconds), atrioventricular (AV) dissociation, presence of fusion or capture beats and an electrical axis between -90 to -180.
What are the 6 causes of pulseless electrical activity?
Various causes of pulseless electrical activity include significant hypoxia, profound acidosis, severe hypovolemia, tension pneumothorax, electrolyte imbalance, drug overdose, sepsis, large myocardial infarction, massive pulmonary embolism, cardiac tamponade, hypoglycemia, hypothermia, and trauma.
Can PEA have P waves?
Rules for PEA and Asystole
Any rhythm including a flat line (asystole). Any rate or no rate. Possible P wave or none detectable. Possible PR wave or none detectable.
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.
What are the 4 shockable rhythms?
Shockable Rhythms: Ventricular Tachycardia, Ventricular Fibrillation, Supraventricular Tachycardia. Much of Advanced Cardiac Life Support (ACLS) is about determining the right medication to use at the appropriate time and deciding when to defibrillate.
How is pulseless electrical activity diagnosed?
The only way to know if a stopped heart involves PEA is with an electrocardiogram, which isn’t always available outside of a hospital setting. Fortunately, the treatment for cardiac arrest is always the same, regardless of whether or not PEA is involved.
Is ventricular fibrillation a form of PEA?
False , VFIB ( Ventricular fibrillation) is an unorganized as where Pea ( Pulseless electrical activity ) is the same organized rhythm.
What is the difference between PEA and asystole?
Asystole is the flatline reading where all electrical activity within the heart ceases. PEA, on the other hand, may include randomized, fibrillation-like activity, but it does not rise to the level of actual fibrillation.
How do you distinguish between pulseless VT and VF?
VF or VFib(Figure 24) is a rapid quivering of the ventricular walls that prevents them from pumping. The emergency condition, pulseless VT, occurs when ventricular contraction is so rapid that there is no time for the heart to refill, resulting in undetectable pulse.
Is V fib pulseless?
Ventricular fibrillation, also known as VFib, and pulseless ventricular tachycardia, also known as V-tach, are lethal dysrhythmias that do not produce a pulse. VFib is the most common initial dysrhythmia in cardiac arrest patients and will regress to asystole if it isn’t treated in a short amount of time.
Do you check pulse in pulseless ventricular tachycardia?
A: If there is no rhythm change and the same waveform of VT continues, you would not need to perform a pulse check. Performing the pulse check would delay the continuation of chest compressions. Once VT is pulseless it is very unlikely that any VT will be able to produce life-sustaining cardiac contractions.
What is a PEA and how is it treated?
PEA is the abbreviation for a type of cardiac arrest known as pulseless electrical activity. PEA is an organized rhythm without a pulse where the electrical activity of the heart may appear normal, but the heart muscle is not responding. Performing high quality CPR is the initial treatment for PEA.
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].
How long can PEA 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.
What do you give for 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.
Why does PEA occur?
PEA is defined as organized ECG activity, excluding ventricular tachycardia and fibrillation, without clinical evidence of a palpable pulse or myocardial contractions. It may occur spontaneously after cardiac arrest or as an intervening rhythm associated with treatment for cardiac arrest.
Why should you not shock PEA?
Why not shock a PEA Arrest? In a PEA arrest, similar to Asystole, the heart doesn’t have the means to use the shock you’re sending it because the primary cause has yet to be corrected. Shocking a heart in PEA arrest is like kicking a comatose patient in the abdomen (which we do not recommend).