Pulseless electrical activity (PEA) and asystole have a special place in our ACLS algorithm. The survival from each of these is different, and it’s vastly different if we misdiagnose a patient with PEA and it’s not.
The ACLA algorithm identifies both as non-shockable rhythms and they are all put into one bucket. They get CPR and adrenaline. We know that giving adrenaline to a shockable rhythm, results in a worse outcome.
We often hear the term pseudo-PEA being used. Let me say that there is no such thing as pseudo PEA. There is either PEA or profound shock.
In PEA, we cannot feel a pulse, ie., the patient is pulseless.. That may be either because the blood pressure is too low to generate a palpable puse (there may still be cardiac activity), or there is no cardiac activity, or there is a pulse and we are simply not feeling it.
The problem with relying on the pulse, is that a false positive will result in withholding CPR and a false negative may result in asynchronous CPR and adrenaline being delivered. Adrenaline given when the heart is already faltering, increases the workload to overcome the increased afterload, which may result in rearrest.
In 2010, the FEEL study showed that in 38% of cases where there was asystole on ECG, there was actually cardiac motion on echo. In 58% of cases of PEA there was actually cardiac motion. So it wasn’t PEA, it was profound shock.
Below short video lecture from EMCORE London 2024 below on PEA.
