Pulseless Electrical Activity

Pulseless electrical activity (PEA) is also referred to as the electromechanical dissociation of the heart. PEA is a condition where there is present the electrical activity of the heart in the ECG, but this activity is not accompanied by heart contractions.


There are a number of possible insults that can cause the PEA. We often name them as the so-called “six T-s and six H-s”. The possible causes are hypothermia (low body temperature), hypoxia (lack of oxygen), hypovolemia (decreased volume of fluids in the blood vessels, for example serious shock conditions), hypoglycemia (low blood sugar), hyperkalemia (high potassium blood level) and hypokalemia (low potassium blood level). The causes starting with letter T are for example trauma (injury), tension pneumothorax (air in the chest cavity with increased pressure), cardiac tamponade, thrombosis (means especially myocardial infarction and pulmonary embolism) and toxic substances.


The condition manifests with the cardiac arrest. The heart doest not function as a pump and this causes an acute cardiovascular failure. The affected person quickly loses consciousness due to brain hypoxia. When untreated, the condition is fatal within few minutes. However, PEA has a very poor prognosis even with an urgent professional medical assistance.


The diagnosis is clear by an unconscious patient with no palpable pulse and with no signs of heart activity, who has positive electrical activity (ECG curve) of the heart found on a monitoring device such as the defibrillator. The electrical activity may resemble normal heart function and there are NOT present serious arrhythmias such as the ventricular tachycardia or ventricular fibrillation.


The only option is a classic cardiopulmonary resuscitation (CPR), which is performed until stating patient's death or restoring normal cardiac function. It should be emphasized that the CPR in pulseless electrical activity includes cardiac massage, mouth-to-mouth breathing and administration of various drugs (epinephrin, etc.), but it does not include the electric defibrillation (administration of electric shocks by using a defibrillator), which is regularly performed in case of ventricular fibrillation. In addition to the resuscitation, it is necessary to urgently treat the cause of PEA, if it is possible.


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Contact: jiri.stefanek@seznam.cz
 Sources: basic text sources