Pulseless Electrical Activity

Pulseless Electrical Activity (PEA) Rhythm

PEA rhythm occurs when any heart rhythm that is observed on the electrocardiogram (ECG) does not produce a pulse. PEA can come in many different forms. Sinus Rhythm, tachycardia, and bradycardia can all be seen with PEA.

Performing a pulse check after a rhythm/monitor check will ensure that you identify PEA in every situation.

Pulseless electrical activity usually has an underlying treatable cause. The most common cause in emergency situations is hypovolemia.

PEA is treated by assessing and correcting the underlying cause. These causes can be summed up in the 6 H’s and 6 T’s of ACLS. Use the link to review the H’s and T’s.

When an underlying cause for pulseless electrical activity cannot be determined, PEA should be treated in the same fashion as asystole

Pulseless electrical activity is treated using the right branch of the pulseless arrest arrest algorithm. Click below to view the pulseless arrest algorithm diagram. When done click again to close the diagram.
Pulseless Arrest Algorithm Diagram.


Question #1: If you saw the rhythm below after defibrillation, how would you determine if it is pulseless electrical activity?

click here for answer

Question #2: What is the most common cause of PEA?
click here for answer

You should check for a carotid or femoral pulse


  1. marianitasolorzano says

    Hi I have an example:
    The patient had a shock because of VF, after the 5 cycles of CPR, he has sinus rhythm but no pulse (PEA).
    Should I keep giving CPR and adrenaline until the patient gets a pulse? While I am looking for reversible causes, should I go on with CPR and adrenaline? Or if I think it`s because of hipovolemia, should I only give solutions?
    Thank you!

    • says

      AHA has removed these from the H and T’s for the following reasons:
      1. Trauma now has it own specific treatment recommendations within AHA ACLS protocol under special resuscitation situations.
      2. Hypoglycemia was removed because the blood glucose check is now a routine standard that is expected to be done with any changes in level of consciousness. It is still very important and should not be neglected.
      Kind regards,

  2. Jordana says

    I might have missed this somewhere on the website, but what is the difference between performing a unsynchronized shock-defibrillation and a synchronized cardioversion? Is this just based on the rhythm identified on the monitor?

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