PEA, pulseless electrical activity 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 Cardiac 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
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 Algorithm 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.