Pulseless electrical activity
| Pulseless electrical activity | |
|---|---|
| Other names | Electromechanical dissociation |
| A drawing of what a rhythm strip showing PEA could look like | |
| Specialty | Emergency Medicine, Cardiology |
| Symptoms | Loss of Consciousness, Respiratory Arrest, Sudden death |
| Complications | Death |
| Risk factors | Certain drug overdoses, Heart attack, Chest trauma, Pulmonary Embolism, Hypoxia, Hypothermia, Hypokalemia, Hyperkalemia, Hypovolemia |
| Diagnostic method | Electrocardiogram |
| Differential diagnosis | Cardiac arrest |
| Treatment | Cardiopulmonary Resuscitation |
| Medication | Epinephrine |
| Prognosis | Poor (2–5% survival rate outside of the hospital) |
| Frequency | Incidence out-of-hospital: 22% to 30% of cardiac arrest events Incidence in-hospital: 35% to 40% of cardiac arrest events |
Pulseless electrical activity (PEA) is a form of 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 20% of out-of-hospital cardiac arrests and about 50% of in-hospital cardiac arrests.
Under normal circumstances, electrical activation of muscle cells precedes mechanical contraction of the heart (known as electromechanical coupling). In PEA, there is electrical activity but insufficient cardiac output to generate a pulse and supply blood to the organs, whether the heart itself is failing to contract or otherwise. While PEA is classified as a form of cardiac arrest, significant cardiac output may still be present, which may be determined and best visualized by bedside ultrasound (echocardiography).
Cardiopulmonary resuscitation (CPR) is the first treatment for PEA, while potential underlying causes are identified and treated. The medication epinephrine (aka adrenaline) may be administered. Survival is about 20% if the event occurred while the patient was already in the hospital setting.