Pulseless Electrical Activity (PEA)

Pulseless electrical activity (PEA), is classified as a form of cardiac arrest. The electrocardiogram (ECG) interpretation displays heart rhythm activity with similarities to a normal sinus rhythm, but the patient has no palpable pulse. In PEA, the heart’s electrical activity is present, but the heart muscle is not responding to the electrical impulses. The electrical activity is dissociated from the mechanical heart function.

Cardiopulmonary resuscitation (CPR) is the prime treatment for PEA. Possible underlying causes should be identified and treated while CPR is in progress. An ACLS practitioner should review the Hs and Ts to help identify and treat the cause of the PEA.

Treatable Causes of Pulseless Electrical Activity (PEA)

• Thrombosis,pulmonary
• Thrombosis, coronary
• Toxins
• Tension pneumothorax
• Tamponade, cardiac
• Hypovolemia
• Hyperkalemia
• Hypoxia
• Hydrogen Ion Excess (acidosis)
• Hypothermia

Signs and Symptoms

A patient with PEA will be unconscious with no breathing and no pulse. PEA leads to a loss of cardiac output and discontinues blood supply to the brain. The skin may appear pallor due to no oxygen in the blood. Make sure to check for a pulse at the carotid artery. You can also check for heart sounds by using a stethoscope for a period of no more than 10 seconds.

Pulseless Electrical Activity (PEA) Diagnosis

An electrocardiogram (ECG/EKG) device is capable of distinguishing PEA from other causes of cardiac arrest. The ECG interpretation can appear the same as a normal sinus rhythm. Therefore in PEA, it is important to treat the symptoms of the patient and not merely the rhythm displayed on the monitor. The absence of a pulse confirms a clinical diagnosis of cardiac arrest. However, in PEA, there is no pulse with an orderly cardiac electrical activity similar to normal sinus, which is not a typical cardiac arrest ECG rhythm like asystole (flatline), ventricular fibrillation or ventricular tachycardia.

Pulseless Electrical Activity (PEA) Treatment

PEA and Asystole treatments are similar. PEA is not shockable. Give CPR. Monitor the ECG and check for a pulse every two minutes. Establish an IV line and administer Epinephrine every 3-5 minutes. If the rhythm becomes shockable, defibrillate. Consider securing an advanced airway, and capnography. Once advanced airway is in placed, give 1 breath every 5-6 seconds (10-12 breaths/min) with continuous chest compressions. Treat the possible causes as you work through H’s and T’s.