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 |
What does PEA look like on an 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). There may be a subtle movement away from baseline (drifting flat-line), but there is no perceptible cardiac electrical activity.
Does PEA look like normal sinus rhythm?
Pulseless Electrical Activity (PEA) Diagnosis
The ECG interpretation can appear the same as a normal sinus rhythm. Therefore in PEA, it is important to treat the symptoms of the patient and not merely the rhythm displayed on the monitor. The absence of a pulse confirms a clinical diagnosis of cardiac arrest.
How would you know your patient is in PEA?
Pseudo-PEA can be detected in the absence of a palpable pulse by: arterial line placement during cardiac arrest (identified by the presence of a blood pressure) high ETCO2 readings in intubated patients. echocardiography or Doppler ultrasound demonstrating cardiac pulsatility.
What rhythm can be in PEA?
PEA encompasses a number of organized cardiac rhythms, including supraventricular rhythms (sinus versus nonsinus) and ventricular rhythms (accelerated idioventricular or escape).
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.
Can you survive PEA?
Patients who have sudden cardiac arrest due to pulseless electrical activity have a poor outcome. In one study of 150 such patients, 23% were resuscitated and survived until hospital admission; only 11% survived until hospital discharge.
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 is a typical cause 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.
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.
What is 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.
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.
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.
What drugs are used for PEA?
Medication Summary
Inotropic, anticholinergic, and alkalinizing agents are used in the treatment of pulseless electrical activity (PEA). As previously stated, resuscitative pharmacology includes epinephrine and atropine.
Do you have a blood pressure in PEA?
However, PEA is not always a cardiac arrest state. In many cases, patients with PEA have underlying cardiac activity and detectable arterial blood pressure.
Does asystole mean death?
Asystole is a type of cardiac arrest, which is when your heart stops beating entirely. This usually makes you pass out. It’s also likely that you’ll stop breathing or that you’ll only have gasping breaths. Without immediate CPR or medical care, this condition is deadly within minutes.
What is the most common underlying potentially reversible cause of pulseless electrical activity?
The most frequent reversible causes of PEA are hypoxia, hypovolemia, hypo-/hyperkalemia, hypo-/hyperthermia, cardiac tamponade, tension pneumothorax, thrombosis (both coronary and pulmonary), and toxins [12].
Can stroke cause PEA?
This serves as a reminder to consider neurologic causes of PEA arrest. There is an association between all causes of cardiac arrest and ischemic stroke, but this occurs in fewer than 4% of cases [2]. A direct correlation between PEA arrest and BAO has not been reported in detail before.
How does pulmonary embolism cause PEA?
The mechanism of cardiac arrest caused by PE is based on pulmonary mainstream obstruction and liberation of vasoconstrictive mediators from the thrombi, leading to increased right ventricular afterload. As the right ventricle fails, right atrial pressure rises and cardiogenic shock ensues.
What happens to the heart during death?
Key facts. When someone is dying, their heartbeat and blood circulation slow down. The brain and organs receive less oxygen than they need and so work less well. In the days before death, people often begin to lose control of their breathing.
What are the first symptoms of bradycardia?
Symptoms of bradycardia include:
- Fatigue or feeling weak.
- Dizziness or lightheadedness.
- Confusion.
- Fainting (or near-fainting) spells.
- Shortness of breath.
- Difficulty when exercising.
- Cardiac arrest (in extreme cases)