Chapter 11 : ACLS Pulseless Electrical Activity

When a patient goes into cardiac arrest, their heart stops beating and they don’t have a pulse and that is when Pulseless electrical activity (PEA) or cardiac contraction occurs. If you eliminate the main cause of PEA arrest, patients with PEA can survive. Even though the heart is producing organized electrical activity, no mechanical activity is produced. There will be no contractions of the cardiac muscles. Any organized rhyme without a pulse is PEA (except VF, VT and asystole) and includes: idioventricular rhythms, ventricular escape rhythms, post-defibrillation idioventricular rhythms, and Bradyasystolic rhythms.

ACLS Pulse-less Electrical Activity Video:

PEA can be caused by many factors and are represented as H’s and T’s:

Scenario: You are the physician on duty and are called to the ER to see a patient who was involved in a motorcycle accident and is now unresponsive.

PEA Assessment:

1. Check for responsiveness – Tap and shout “Are you alright?” and look at chest for movement.  Check carotid pulse and note no pulse is present
2. Call a code and get the code team in place

PEA Interventions:

1. If no pulse, immediately start compressions at a rate of 100 compressions per minute and allow chest to recoil. 30 compressions to 2 breaths. Once team is in place, one person will be responsible for the compressions and one for breaths using a BVM.
2. Attach monitor and check for shockable rhythm, if no shockable rhythm present, the patient is in asystole or PEA, continue CPR for 2 mins and obtain IV/IO access Management:  Initiate the cardiac arrest algorithm on the right if the patient still has no pulse and does not respond to BLS

1. Once IV/IO access is obtained give the following drugs:
   1. Epinephrine 1 mg IV/IO and repeat every 3 to 5 minutes
2. Maintain advanced airway and capnography if needed
3. Pause and check for shockable rhythm.  If not shockable , continue CPR for 2 minutes and try to treat the reversible causes

The following is an algorithm shows management of cardiac arrest due to asystole/PEA (left side of chart)

To ensure the best outcome for PEA it is vital to have uninterrupted, high quality CPR and to quickly figure out the reversible causes.

Learning Outcomes:

You have completed Chapter XI. Now you should be able to:

1. Apply the Cardiac Arrest Algorithm to PEA
2. Recognize PEA in a patient
3. Understand the H’s & T’s in relation to PEA/Asystole
4. Understand the treatments used in PEA