PEA (Pulseless Electrical Activity)

PEA is defined as any organized rhythm without a palpable pulse and is the most
common rhythm present after defibrillation. PEA along with asystole make up half of the
Pulseless Arrest Algorithm with VF and VT consisting of the other half. Patients with PEA
usually have poor outcomes.

Positive outcome of an attempted resuscitation depends primarily on two actions: 1.

Providing effective CPR; and 2. Identification and correction of the cause of PEA.

Medications used in PEA

Atropine is no longer recommended for the treatment of PEA per the 2010 ACLS
guidelines.

There are 2 medications used in the PEA algorithm, epinephrine and vasopressin. These
medications should be given while maintaining high-quality CPR. 1 milligram of
epinephrine is given IV or IO every 3-5 minutes. 40 Units of vasopressin can be given IV
or IO to replace the first or second dose of epinephrine.
Click below to view the pulseless arrest algorithm diagram. When done click again to
close the diagram.Pulseless Arrest Algorithm Diagram. or Members Download the Hi-
Resolution PDF Here.

Vasopressors have not been shown to increase survival from PEA

Hs and Ts
The identification and correction of the causes of PEA should be a high priority as
a cardiac emergencyprogresses. One easy way to remember the most common causes
of PEA as well as other cardiac emergencies is the Hs and Ts of ACLS. See the Hs
and Ts page for more information on the causes and treatment of PEA.