What is the management
strategy for pulseless electrical activity (PEA)?
PEA refers to the clinical picture of cardiac
electrical activity without a detectable pulse. VF, VT, and asystole are
specifically excluded from the wide range of electrical activity that may
present. The ACLS guidelines emphasize the search for reversible causes of PEA.
This must not exclude basic resuscitation measures, which should be started as
soon as possible. After VF/pulseless VT have been ruled out, securing an
airway, oxygen administration, and chest compressions must be the primary task.
The etiology of PEA must now be sought. Table 1.2 lists the most frequent
causes of PEA.
First-line drugs in the continuing resuscitation algorithm include epinephrine 1 mg i.v. push every 3–5 minutes and atropine 1 mg i.v. every 3–5 minutes as needed
when the underlying PEA rate is slow. Nevertheless, treatment of PEA is not
limited to these drugs and pharmacologic treatment of a patient with PEA must
be customized to the suspected underlying cause. PEA is not an indication for
defibrillation. “Shockable” rhythms have to be ruled out. Once a patient
converts to VF/pulseless VT, however, the appropriate algorithm should be