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
Vasopressors
A vasopressor is a medication that produces vasoconstriction and a rise in blood pressure. The vasopressor that is used for the treatment within the right branch of the Cardiac Arrest Algorithm is epinephrine.
Epinephrine is primarily used for its vasoconstrictive effects. Vasoconstriction is important during CPR because it will help increase blood flow to the brain and heart.
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.
For PEA a rhythm and pulse check should be performed after 5 cycles of CPR. Limit the rhythm/pulse check to less than 10 seconds to minimize interruptions in CPR. The pulse check should be performed simultaneously with the rhythm check when treating PEA since by definition PEA is an organized rhythm and could have a pulse that generates blood perfusion.
View the cardiac arrest algorithm diagram. When done close the diagram.
Cardiac Arrest Diagram
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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.
mb says
how can i distinguish specially between PEA or the rhythm is just some adrenaline effect or chest compression effect?
ACLS says
In CPR with monitoring, it can be challenging to distinguish between PEA (Pulseless Electrical Activity) and the effects of adrenaline or chest compressions on the rhythm. PEA is typically identified by the presence of organized electrical activity on the monitor without a detectable pulse. If you observe a rhythm on the monitor but cannot feel a pulse, it may indicate PEA. However, factors like adrenaline or chest compressions can also influence the rhythm.
To differentiate, focus on assessing the patient’s overall response to interventions. If there’s no improvement in pulse despite interventions, it may lean towards PEA.
Kind regards,
Jeff
Joy says
Hi,
I have a doubt. In a scenario where there is a cardiac arrest and resuscitation in progress, the patient has been administered adrenaline at the beginning of this 2minute round after being defibrillated in the prev cycle as he was in VF. Now during the rhythm evaluation, you find him to be in PEA, would you then repeat a dose of adrenaline? (which would mean adrenaline in 2 consecutive rounds).
ACLS says
Technically, you would want to wait at least three minutes after the first administration of Adrenaline to provide a second dose. Kind regards, Jeff
Paul Abate says
Very true. EPI is given every 3-5 minutes while CPR is being performed regardless of the EKG rhythm.
YK says
Should ventricular standstill be regarded as PEA?
ACLS says
Ventricular standstill would be considered ventricular asystole. There would be p-waves being generated but the impulse is not being conducted to the ventricles. Kind regards, Jeff
Do Van Minh says
Hello,
I have a question about role of sodium bicarbonate in cardiac arrest. Should we administration NaHCO3 during CPR.
Thanks.
ACLS says
Sodium bicarbonate is not included in any of the ACLS algorithms. Its use would be more conducive with the post cardiac arrest phase. All use within the cardiac arrest algorithms has long been discontinued because there was no data that showed the administration of sodium bicarbonate improved survival to hospital discharge. Kind regards, Jeff
Schelly says
When treating a patient in PEA or Cardiac Arrest, is it the standard of care to NOT check for a pulse but rely on your ETCO2 reading instead?
ACLS says
I think it would be a question of whether you had ETCO2 available. There are many hospitals where ETCO2 is not available in the setting where a cardiac arrest event occurs.
As far as a general standard of care I would not say that healthcare has come to the place of determining that ETCO2 is the Standard of care over checking for a pulse during a cardiac arrest event.
Kind regards,
Jeff
Kay says
So for pea, the pulse and rhythm checks are not done every 2 minutes like in asystole? Or is it cpr for 5 rounds and then rhythm check every 2 minutes? Thanks
ACLS says
A rhythm check is always performed every two minutes. When dealing with asystole you will only perform a pulse check if an organized rhythm is present. otherwise, there’s no need to check for a pulse if there is no organized rhythm.
Kind regards,
Jeff
Kuburat Agyemang-Boakye says
Hello,
I need the treatment Algorithm for pulseless patient in code blue with a history of DVT and A-Fib
ACLS says
You would use the cardiac arrest algorithm, and use the left branch if the patient has VF or pulseless VT. Use the right branch if the patient has PEA or asystole. When dealing whether cardiac arrest, the history of DVT and AFib will not change the algorithm used. The history will help guide your assessment of the H’s and T’s.
Kind regards, Jeff