Pulseless electrical activity causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Pulseless electrical activity is the initial presenting rhythm in 19.6% of patients who are monitored at the onset of cardiac arrest and 16.5% of patients who present to a prehospital system in full cardiac arrest. [1]

Causes

Life Threatening Causes

Pulseless electrical activity is a life-threatening condition and must be treated as such irrespective of the causes. Life-threatening conditions can result in death or permanent disability within 24 hours if left untreated.

Common Causes

Common causes of PEA include preceding respiratory failure in 40% to 50% of cases, and hypovolemia. The common causes of PEA can be remembered using the mnemonic "The Hs and Ts".[2][3][4]

As noted by repeated balloon inflations in the cardiac catheterization laboratory, transient occlusion of the coronary artery does not cause PEA.

Causes by Organ System

Cardiovascular Acute coronary syndrome, acute rheumatic fever, Andersen cardiodysrhythmic periodic paralysis, Brugada syndrome, cardiac tumor, complete heart block, congenital heart disease, congestive heart failure, dilated cardiomyopathy, hypertensive heart disease, hypertrophic cardiomyopathy, ischemic heart disease, Jervell and Lange-Nielsen syndrome, Lev's disease, long QT syndrome, myocardial bridging, myocardial infarction, myocarditis, NSTEMI, pericarditis, Romano-Ward syndrome, STEMI, Timothy syndrome, valvular heart disease
Chemical/Poisoning Carbamate poisoning, organophosphate poisoning, parathion poisoning
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect Amiodarone, anthracyclines, beta-blockers, calcium channel blockers, cholinesterase inhibitors, daunorubicin, digitalis, doxorubicin, edrophonium, epirubicin, idarubicin, neostigmine, procainamide, propafenone, propofol, pyridostigmine, quinidine, tramadol
Ear Nose Throat No underlying causes
Endocrine Diabetic ketoacidosis, hypoglycemia
Environmental Hypothermia
Gastroenterologic No underlying causes
Genetic Andersen cardiodysrhythmic periodic paralysis, Brugada syndrome, congenital heart block, congenital heart disease, Emery-Dreifuss muscular dystrophy, Jervell and Lange-Nielsen syndrome, Kearns-Sayre syndrome, limb-girdle muscular dystrophy type 1B (LGMD1B), muscular dystrophy, myotonic dystrophy, Romano-Ward syndrome, Timothy syndrome
Hematologic No underlying causes
Iatrogenic Cardiac catheterization, cardiac resynchronization therapy, cardiac transplantation, coronary artery bypass grafting, heart surgery, hypertrophic cardiomyopathy alcohol septal ablation, infraclavicular brachial plexus block
Infectious Disease Acute rheumatic fever, aspiration pneumonia, myocarditis, pericarditis, septic shock
Musculoskeletal/Orthopedic Muscular dystrophy, myotonic dystrophy, Timothy syndrome
Neurologic Seizure
Nutritional/Metabolic Hypermagnesemia, hypocalcemia, metabolic acidosis
Obstetric/Gynecologic No underlying causes
Oncologic Cardiac tumor
Ophthalmologic No underlying causes
Overdose/Toxicity Alcohol, amiodarone, anthracyclines, cholinesterase inhibitors, propofol, quinidine, tramadol
Psychiatric Takotsubo cardiomyopathy, severe anorexia nervosa
Pulmonary Hypoxia, aspiration pneumonia, bronchospasm
Renal/Electrolyte Hyperkalemia, renal failure
Rheumatology/Immunology/Allergy Acute rheumatic fever, neonatal lupus erythematosus
Sexual No underlying causes
Trauma Myocardial contusion, severe brain injury
Urologic No underlying causes
Miscellaneous No underlying causes

Causes in Alphabetical Order

References

  1. Stueven H, Troiano P, Thompson B, Mateer JR, Kastenson EH, Tonsfeldt D; et al. (1986). "Bystander/first responder CPR: ten years experience in a paramedic system". Ann Emerg Med. 15 (6): 707–10. PMID 3706861.
  2. ACLS: Principles and Practice. p. 71-87. Dallas: American Heart Association, 2003. ISBN 0-87493-341-2.
  3. ACLS for Experienced Providers. p. 3-5. Dallas: American Heart Association, 2003. ISBN 0-87493-424-9.
  4. "2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care - Part 7.2: Management of Cardiac Arrest." Circulation 2005; 112: IV-58 - IV-66.

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