Pulseless electrical activity (patient information)

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief:; Assistant Editor(s)-In-Chief:

Absence of palpable pulses is the main finding. Depending upon the cause, the following might be found:

• Tracheal deviation in or the unilateral absence of breath sounds in tension pneumothorax
• Decreased skin turgor
• Traumatic chest
• Cool extremities 
• Tachycardia
• Cyanosis

Common causes of PEA include preceding respiratory failure in 40% to 50% of cases, and hypovolemia. The common causes of PEA can be remembered using the mnemonic “The Hs and Ts”.

• Hypovolemia
• Hypoxia
• Hydrogen ions (Acidosis)
• Hypothermia
• Hyperkalemia or Hypokalemia
• Hypoglycemia
• Tablets or Toxins (Drug overdose) such as beta blockers, tricyclic antidepressants, or calcium channel blockers
• Tamponade
• Tension pneumothorax
• Thrombosis (Myocardial infarction)
• Thrombosis (Pulmonary embolism)
• Trauma (Hypovolemia from blood loss)
• Covid-19

• Age i.e elderly
• Black race
• Female gender
• Heart failure patients
• Pulmonary disease
• Syncope

The current American Heart Association-Advanced Cardiac Life Support (AHA-ACLS) guidelines advise the following be undertaken in all patients:

• Start CPR immediately
• Administer 100% oxygen to reverse hypoxia
• Intubate the patient
• Establish IV access

The mainstay of drug therapy for PEA is epinephrine 1mg every 3–5 minutes. Higher doses of epinephrine can be administered in patients with suspected beta blocker and calcium channel blocker overdose. Otherwise high dose epinephrine has not demonstrated a benefit in survival or neurologic recovery.

Directions to Hospitals Treating Condition

There are no established preventive measures for pulseless electrical activity.

The overall prognosis is poor for pulseless electrical activity unless any reversible causes exists. Also the more abnormal the Ecg findings on intial admission the more worse the prognosis.The time to intiate CPR also plays a pivotal role in prognosis. Persons who got CPR by a layperson or bystander and immediate defibrillation are noted to have better outcome after out-of-hospital udden cardiac arrest(SCA).

The following complications are mostly seen in pulseless electrical activity:

• Rib fractures due to repeated chest compressions during CPR
• Poor perfusion can lead to Ischemia of extremities
• Anoxic brain injury

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