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, Brugada syndrome, cardiac amyloidosis[6],Cardiac tamponade, cardiac tumor, complete heart block, congenital heart disease, congestive heart failure, dilated cardiomyopathy, hypertensive heart disease, hypertrophic cardiomyopathy, ischemic heart disease, long QT syndrome, myocardial infarction, myocarditis, NSTEMI, pericarditis, Rheumatic valvular disease[7], STEMI, valvular heart disease
Chemical/Poisoning Alcohol
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect beta-blockers, calcium channel blockers,digitalis, methylphenidate[8], propofol, pyridostigmine, quinidine, risperidone[9]
Ear Nose Throat No underlying causes
Endocrine Diabetic ketoacidosis, hypoglycemia
Environmental Hypothermia
Gastroenterologic No underlying causes
Genetic Brugada syndrome, congenital heart block, congenital heart disease, Kearns-Sayre syndrome
Hematologic No underlying causes
Iatrogenic cardiac transplantation, coronary artery bypass grafting, heart surgery, hypertrophic cardiomyopathy alcohol septal ablation[10]postdefibrillation[11]
Infectious Disease aspiration pneumonia, myocarditis, pericarditis, septic shock
Musculoskeletal/Orthopedic No underlying causes
Neurologic Seizure
Nutritional/Metabolic Hypermagnesemia, metabolic acidosis
Obstetric/Gynecologic No underlying causes
Oncologic Cardiac tumor
Ophthalmologic No underlying causes
Overdose/Toxicity Alcohol[12], propofol, quinidine
Psychiatric Takotsubo cardiomyopathy
Pulmonary Aspiration pneumonia, bronchospasm, hypoxia, tension pneumothorax
Renal/Electrolyte Hyperkalemia, Hypovolemia, renal failure
Rheumatology/Immunology/Allergy Cardiac amyloidosis[6], Rheumatic valvular disease
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.
  5. Sandberg WS (2005). "Endobronchial blocker dislodgement leading to pulseless electrical activity". Anesth Analg. 100 (6): 1728–30. doi:10.1213/01.ANE.0000149895.99151.20. PMID 15920204.
  6. 6.0 6.1 6.2 Hess EP, White RD (2004). "Out-of-hospital cardiac arrest in patients with cardiac amyloidosis: presenting rhythms, management and outcomes in four patients". Resuscitation. 60 (1): 105–11. doi:10.1016/j.resuscitation.2003.08.007. PMID 14987790.
  7. Virkkunen I, Paasio L, Ryynänen S, Vuori A, Sajantila A, Yli-Hankala A; et al. (2008). "Pulseless electrical activity and unsuccessful out-of-hospital resuscitation: what is the cause of death?". Resuscitation. 77 (2): 207–10. doi:10.1016/j.resuscitation.2007.12.006. PMID 18249482.
  8. 8.0 8.1 Daly MW, Custer G, McLeay PD (2008). "Cardiac arrest with pulseless electrical activity associated with methylphenidate in an adolescent with a normal baseline echocardiogram". Pharmacotherapy. 28 (11): 1408–12. doi:10.1592/phco.28.11.1408. PMID 18957001.
  9. 9.0 9.1 Ravin DS, Levenson JW (1997). "Fatal cardiac event following initiation of risperidone therapy". Ann Pharmacother. 31 (7–8): 867–70. PMID 9220048.
  10. 10.0 10.1 ten Cate FJ, Soliman OI, Michels M, Theuns DA, de Jong PL, Geleijnse ML, Serruys PW (2010). "Long-term outcome of alcohol septal ablation in patients with obstructive hypertrophic cardiomyopathy: a word of caution". Circulation. Heart Failure. 3 (3): 362–9. doi:10.1161/CIRCHEARTFAILURE.109.862359. PMID 20332420. Retrieved 2012-02-11. Unknown parameter |month= ignored (help)
  11. 11.0 11.1 Geddes LA, Roeder RA, Rundell AE, Otlewski MP, Kemeny AE, Lottes AE (2006). "The natural biochemical changes during ventricular fibrillation with cardiopulmonary resuscitation and the onset of postdefibrillation pulseless electrical activity". Am J Emerg Med. 24 (5): 577–81. doi:10.1016/j.ajem.2006.01.030. PMID 16938597.
  12. Stueven HA, Aufderheide T, Waite EM, Mateer JR (1989). "Electromechanical dissociation: six years prehospital experience". Resuscitation. 17 (2): 173–82. PMID 2546233.

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