pulseless electrical activity; electromechanical dissociation (PEA)

Classification

ECG electrical activity other than VF/VT

• electromechanical dissociation
• idioventricular rhythms
• ventricular escape rhythms
• bradyasystolic rhythm
• postdefibrillation idioventricular rhythms

Etiology

• hypovolemia
• hypoxemia
• cardiac tamponade
• tension pneumothorax
• hypothermia
• massive pulmonary embolus
• drug overdose
• hyperkalemia
• severe acidosis
• massive acute myocardial infarction

Diagnostic procedures

• point-of-care ultrasound
  • lack of cardiac activity portends poor prognosis

Management

• assess for presence of pulse, begin CPR if no pulse
  • recheck for pulse after 2 minutes of CPR
• cardiac monitor to assess rhythm
• use Doppler to assess blood flow
  • if blood flow, treat for severe hypotension
  • if no blood flow continue CPR
• establish IV access
• intubate (IV access takes precedence over intubation)
• consider possible causes & treat
• epinephrine 1 mg IV push every 3-5 min
  • administration of 1st dose within 1 to 3 minutes
  • longer time to epinephrine administration is associated with diminished survival in children with in-hospital cardiac arrest & pulseless electrical activity
• atropine no longer recommended
• adenosine may be used
• if no response
  • high dose epinephrine *
  • NaHCO3 if appropriate #

* high dose epinephrine: 2-5 mg IV push every 3-5 min; 1 mg, 3 mg, 5 mg 3 minutes apart; 0.1 mg/kg every 3-5 min

# NaHCO3 not indicated early in resuscitation, acidosis is generally secondary to inadequate ventilation, dose is 1 meq/kg IV followed by 0.5 meq/kg every 10 min

More general terms

• cardiac arrhythmia