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Pulseless electrical activity, most commonly known as PEA, is a condition where the electrical activity of the heart is not accompanied by a palpable or effective pulse. It's important to find out the potential cause, correct it, and hopefully get a pulse back for that patient.
In this lesson, we'll look closer at PEA, outline several possible causes, including an important caveat or warning. And at the end of the lesson, we'll provide an additional Word on pulseless electrical activity.
Treatable Causes for PEA
It's always important to treat the patient's symptoms, rather than rely on the ECG readout alone. Underlying and treatable causes for PEA include:
- Pulmonary thrombosis
- Coronary thrombosis
- Tension pneumothorax
- Cardiac tamponade
- Hypovolemia
- Hyperkalemia
- Hypoxia
- Hydrogen ion (acidosis)
Pro Tip: It's important to rule out any and all of the treatable H's and T's as underlying causes for pulseless electrical activity in order to correct the mechanical disassociation that could be causing the cardiac arrest.
Warning: The ECG interpretation for a patient exhibiting signs of PEA could be the same as normal sinus rhythm. Which is why treating the patient's symptoms, particularly when it comes to pulseless electrical activity, is so important. Rather than merely reacting to and relying on the rhythms that are being displayed on the ECG monitor.
An Additional Word on Pulseless Electrical Activity
Pulseless electrical activity (PEA) is not a specific rhythm. Instead it's a term used to describe any organized electrical activity – but not VFib or asystole — on an ECG or cardiac monitor that is associated with no palpable pulses.
Pulsations can be detected by an arterial waveform or Doppler study. However, pulses are not palpable. The rate of electrical activity may be slow (which is most common), normal, or fast. Very slow PEA can also be referred to as agonal.
When a patient is in PEA, the ECG can display normal or wide QRS complexes, as well as other abnormalities, which include:
- Low or high-amplitude T-waves
- Prolonged PR and QT intervals
- Atrioventricular disassociation
- Complete heart block
- Ventricular complexes without P-waves
It's important to remember to assess the patient's monitored rhythm and note the rate and width of the QRS complexes. And as mentioned above, PEA can be caused by reversible conditions easily remembered as the H's and T's.
Warning: One important takeaway is this: Unless you can quickly identify and treat the cause of PEA, the rhythm will likely deteriorate to asystole.
The adult cardiac arrest algorithm is the most important algorithm to know for adult resuscitation. This algorithm outlines all of the assessment and management steps you'll need to know for all pulseless patients who do not initially respond to basic life support interventions, including the first shock from an AED.
The algorithm consists of the two pathways for a cardiac arrest:
- A shockable rhythm, such as VFib or pulseless V-tach
- A non-shockable rhythm, such as asystole or PEA
Common medications used to treat VFib or pulseless V-tach include:
- Epinephrine
- Norepinephrine
- Lidocaine
- Magnesium sulfate
- Dopamine
- Oxygen
- Other medications, depending on the cause of the V-tach or pulseless V-tach arrest
Common medications used to treat asystole and PEA include:
- Epinephrine
- Other medications, depending on the cause of the asystole or PEA arrest
