Pulseless electrical activity natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Karol Gema Hernandez, M.D. [2]

Overview

PEA is associated with a poor prognosis, particularly if the underlying cause is not readily identified and treated. The presence of a QRS interval > 0.20 seconds is associated with a poorer prognosis. The survival of patients with PEA as a presenting rhythm for sudden cardiac arrest is poorer than ventricular tachycardia or ventricular fibrillation.^[1]

Natural History

The symptoms of (disease name) usually develop in the first/ second/ third decade of life, and start with symptoms such as ___.
The symptoms of (disease name) typically develop ___ years after exposure to ___.
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].

Complications

Common complications of [disease name] include:
- [Complication 1]
- [Complication 2]
- [Complication 3]

Prognosis

Prognosis is generally poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [–]%.
Depending on the extent of the [tumor/disease progression] at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as poor/good/excellent.
The presence of [characteristic of disease] is associated with a particularly [good/poor] prognosis among patients with [disease/malignancy].
The prognosis varies with the [characteristic] of tumor; [subtype of disease/malignancy] have the most favorable prognosis.

Natural History, Complications and Prognosis

The survival of patients with out of hospital occurrence of PEA is 19.5% compared to 11.2% among patients with in hospital PEA, likely due to the higher incidence of reversible causes among patients with out of hospital arrest.^[1]^[2]^[3]

Among 11,963 patients with PEA, only 11% survived, 62% of which had good neurological outcomes.^[4]

According to the Resuscitation Outcomes Consortium, the survival of patients with SCA during hospitalization is 8% among subjects with PEA compared to 30.5% for subjects with VT or VF; therefore, strategies for improving survival after PEA due to SCA should be implemented.

References

↑ ^1.0 ^1.1 Meaney PA, Nadkarni VM, Kern KB, Indik JH, Halperin HR, Berg RA (2010). “Rhythms and outcomes of adult in-hospital cardiac arrest”. Critical Care Medicine. 38 (1): 101–8. doi:10.1097/CCM.0b013e3181b43282. PMID 19770741. Retrieved 2012-09-16. Unknown parameter |month= ignored (help)
↑ Thomas AJ, Newgard CD, Fu R, Zive DM, Daya MR (September 2013). “Survival in out-of-hospital cardiac arrests with initial asystole or pulseless electrical activity and subsequent shockable rhythms”. Resuscitation. 84 (9): 1261–6. doi:10.1016/j.resuscitation.2013.02.016. PMC 3947599. PMID 23454257.
↑ Teodorescu C, Reinier K, Uy-Evanado A, Ayala J, Mariani R, Wittwer L, Gunson K, Jui J, Chugh SS (September 2012). “Survival advantage from ventricular fibrillation and pulseless electrical activity in women compared to men: the Oregon Sudden Unexpected Death Study”. J Interv Card Electrophysiol. 34 (3): 219–25. doi:10.1007/s10840-012-9669-2. PMC 3627722. PMID 22406930.
↑ Nadkarni VM, Larkin GL, Peberdy MA, Carey SM, Kaye W, Mancini ME; et al. (2006). “First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults”. JAMA. 295 (1): 50–7. doi:10.1001/jama.295.1.50. PMID 16391216.

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[pmid19770741-1] 1.0 ^1.1 Meaney PA, Nadkarni VM, Kern KB, Indik JH, Halperin HR, Berg RA (2010). “Rhythms and outcomes of adult in-hospital cardiac arrest”. Critical Care Medicine. 38 (1): 101–8. doi:10.1097/CCM.0b013e3181b43282. PMID 19770741. Retrieved 2012-09-16. Unknown parameter |month= ignored (help)

[pmid23454257-2] Thomas AJ, Newgard CD, Fu R, Zive DM, Daya MR (September 2013). “Survival in out-of-hospital cardiac arrests with initial asystole or pulseless electrical activity and subsequent shockable rhythms”. Resuscitation. 84 (9): 1261–6. doi:10.1016/j.resuscitation.2013.02.016. PMC 3947599. PMID 23454257.

[pmid22406930-3] Teodorescu C, Reinier K, Uy-Evanado A, Ayala J, Mariani R, Wittwer L, Gunson K, Jui J, Chugh SS (September 2012). “Survival advantage from ventricular fibrillation and pulseless electrical activity in women compared to men: the Oregon Sudden Unexpected Death Study”. J Interv Card Electrophysiol. 34 (3): 219–25. doi:10.1007/s10840-012-9669-2. PMC 3627722. PMID 22406930.

[pmid16391216-4] Nadkarni VM, Larkin GL, Peberdy MA, Carey SM, Kaye W, Mancini ME; et al. (2006). “First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults”. JAMA. 295 (1): 50–7. doi:10.1001/jama.295.1.50. PMID 16391216.

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