PEA (Pulseless Electrical Activity)
PEA is defined as any organized rhythm without a palpable pulse and is the most common rhythm present after defibrillation. PEA along with asystole make up half of the Pulseless Arrest Algorithm with VF and VT consisting of the other half. Patients with PEA usually have poor outcomes.
Positive outcome of an attempted resuscitation depends primarily on two actions: 1. Providing effective CPR; and 2. Identification and correction of the cause of PEA.
Medications used in PEA
Atropine is no longer recommended for the treatment of PEA per the 2010 ACLS guidelines.
There are 2 medications used in the PEA algorithm, epinephrine and vasopressin. These medications should be given while maintaining high-quality CPR. 1 milligram of epinephrine is given IV or IO every 3-5 minutes. 40 Units of vasopressin can be given IV or IO to replace the first or second dose of epinephrine.
Vasopressors have not been shown to increase survival from PEA
H’s and T’s
The identification and correction of the causes of PEA should be a high priority as a cardiac emergency progresses. One easy way to remember the most common causes of PEA as well as other cardiac emergencies is the H’s and T’s of ACLS. See the H’s and T’s page for more information on the causes and treatment of PEA.