Pseudo-pulseless electrical activity in the emergency department, an evidence based approach

Rabjohns, Jennifer; Quan, Theodore; Boniface, Keith; Pourmand, Ali

doi:10.1016/j.ajem.2019.158503

Cited by 42 publications

(35 citation statements)

References 21 publications

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“…One suggestion, from Myerburg et al, is that "PEA is a syndrome characterized by the absence of a palpable pulse in an unconscious patient with organized electric activity other than ventricular tachyarrhythmia on ECG" 55 . Another form of PEA is so called pseudo-PEA which can be described as a state without palpable pulse but with cardiac activity and ventricular contractions which can be detected by ultrasound 56 .…”

Section: Pulseless Electrical Activity (Pea) In Relation To Etiologymentioning

confidence: 99%

Focused cardiac ultrasound after return of spontaneous circulation in cardiac-arrest patients

et al. 2019

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Section: Pulseless Electrical Activity (Pea) In Relation To Etiologymentioning

confidence: 99%

Focused cardiac ultrasound after return of spontaneous circulation in cardiac-arrest patients

et al. 2019

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“…In Europe, annual incidences up to 119 per 100,000 adults have been reported [1]. Despite considerable efforts to improve the various links in the chain of survival, out-of-hospital cardiac arrest (OHCA) remains associated with an exceptionally poor prognosis [2][3][4][5][6]. As the proportion of CAs with pulseless electrical activity (PEA) as initial rhythm is increasing, this particular subtype is the main subject of this review [4].…”

Section: Introductionmentioning

confidence: 99%

“…This should however be differentiated from pseudo PEA in which some cardiac movement is still present although not powerful enough to produce adequate circulation. This is often caused by a severe shock state (such as hypovolemia or obstruction of cardiac output) [9]. If the underlying cause is not reversed, the heart continues to pump despite an ongoing depletion of oxygen and metabolic supplies.…”

Section: Introductionmentioning

confidence: 99%

Pulseless Electrical Activity: Detection of Underlying Causes in a Prehospital Setting

2020

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The proportion of out-of-hospital cardiac arrests (OHCA) with pulseless electrical activity (PEA) as initial rhythm is increasing. PEA should be managed by identifying the underlying cause of the arrest and treating it accordingly. This often poses a challenge in the chaotic prehospital environment with only limited resources available. The aim of this study was to review the diagnostic tools, available in a prehospital setting, and their interpretation during cardiac arrest with PEA as initial rhythm. A systematic literature search of the Pubmed database was performed. Articles were assessed for eligibility by title, abstract and full text. Ultrasonography has become a great asset in detecting underlying causes and a variety of protocols have been proposed. There are currently no studies comparing these protocols regarding their feasibility and their effect on patient survival. Further research concerning the relationship between ECG characteristics and underlying causes is required. Limited evidence suggests a role for point-of-care testing in detecting hyperkalemia and a role for capnography in the diagnosis of asphyxia cardiac arrest. Multiple studies describe a prognostic potential. Although evidence about the prognostic potential of cerebral oximetry in OHCA is accumulating, its diagnostic potential is still unknown. In the management of OHCA, anamnestic and clinical information remains the initial source of information in search for an underlying cause. Ultrasonographic evaluation should be performed subsequently, both for detecting an underlying cause and discriminating between true PEA and pseudo-PEA. Comparative studies are required to identify the best ultrasonographic protocol, which can be included in resuscitation guidelines.

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“…The growing adoption of bedside ultrasound allowed to classify PEA in two groups: the true pulseless electrical activity (PEA) and the pseudo-pulseless electrical activity (pPEA). pPEA is used to describe a patient who has a supposed PEA in the absence of pulse, with evidence of some cardiac activity on the bedside ultrasound [4]. Some reports have shown that pPEA has a better prognosis than true PEA with regard to return of spontaneous circulation (ROSC) and higher survival rates [5,6].…”

Section: Introductionmentioning

confidence: 99%

Rhythms and prognosis of patients with cardiac arrest, emphasis on pseudo-pulseless electrical activity: another reason to use ultrasound in emergency rooms in Colombia

2020

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Background The cardiac arrest is still an emergency with a bad prognosis. The growing adoption of bedside ultrasound allowed to classify PEA in two groups: the true PEA and the pseudo-PEA. pPEA is used to describe a patient who has a supposed PEA in the absence of pulse, with evidence of some cardiac activity on the bedside ultrasound. Objective This work aims to assess the bedside ultrasound use as a predictor for ROSC and survival at discharge in cardiac arrest patients and compare the pseudo-pulseless electrical activity to other cardiac arrest rhythms, including shockable rhythms. Materials and methods This is an observational, historic cohort study carried out in the emergency room of the University Hospital Mayor Méderi. Data were collected from all the adult patients treated for cardiac arrest from June 2018 to 2019. An ultrasound was performed to every cardiac arrest patient. Results Of a total of 108 patients, the median of the age was 71 years, 65.8% were male subjects, and the most frequent cause for cardiac arrest was the cardiogenic shock (32.4%). ROSC was observed in 41 cases (37.9%) and survival at discharge was 18 cases (16.7%). VF/VT and pPEA were the two rhythms that showed the highest ROSC and survival at discharge. For the pPEA group, we were able to conclude that the cardiac activity type is related to ROSC. Conclusion There is a significant difference for ROSC and survival at discharge prognosis among the cardiac arrest rhythms, with better outcomes for VF/VT and pPEA. Among patients with PEA, a routine ultrasound assessment is recommended. The type of cardiac activity recorded during the ultrasound of the cardiac arrest patient might be related to the ROSC and survival at discharge prognosis.

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Pseudo-pulseless electrical activity in the emergency department, an evidence based approach

Cited by 42 publications

References 21 publications

Focused cardiac ultrasound after return of spontaneous circulation in cardiac-arrest patients

Focused cardiac ultrasound after return of spontaneous circulation in cardiac-arrest patients

Pulseless Electrical Activity: Detection of Underlying Causes in a Prehospital Setting

Rhythms and prognosis of patients with cardiac arrest, emphasis on pseudo-pulseless electrical activity: another reason to use ultrasound in emergency rooms in Colombia

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