Pulseless Electrical Activity (PEA)

Question 1

Pulseless Electrical Activity (PEA) - Definition

Answer 1

Maintenance of electrical activity in the face of complete pump failure

Question 2

Goal of Care

Answer 2

High quality CPR, cardiac arrest management and return of spontaneous circulation

Question 3

Cues

Answer 3

Cardiac arrest w/ “no shock” advised by AED or ECG interpretation by ACP

Question 4

Guiding Principles

Answer 4

PEA has a poor outcome unless a reversible cause can be treated

Consider treatable cuases of cardiac arrest, as indicated - and act on any that you can confirm or believe are highly likely

Question 5

Specific Therapies - Fluid Bolus

Answer 5

• use of a fluid bolus (500-1000mls NS) and EPI 1mg q 3 mins may be beneficial in many of the causes of PEA

Question 6

Specific Therapies - Cardioversion

Answer 6

Cadioversion is indicated for a narrow complex PEA no discernible P waves and heart rate > 160

Synchronized cardio version is the preferred therapy to avoid shock deliver during the relative refractory period, possibly producing ventricular fibrillation.

Unsynchronized cardio version is acceptable practice if the monitor is unable to flag the QRS and “sync”

Question 7

PEA - Intervention Guidelines

Answer 7

EMR/PCP
CPR and AED per CAM guidelines

ACP/CCP
Treat precipitating cause
Sympathomimetic
 - Epi
Increase Pre-load
- fluid bolus 500-1000mls NS

Question 8

Further Care

Answer 8

In-hospital treatment is diagnosis dependant
May include:
Chest tube thoracostomy or needle aspiration

Drainage of acute tamponade; thoracotomy for penetrating trauma with loss of vitals enroute or in ED

Aggressive fluid replacement including blood products for suspected hemorrhagic shock; Inotropes as indicated;

Aggressive medical treatment of acute poisonings;

Aggressive re-warming if hypothermia present and suspected to be primary cause of presentation