In contrast to arrhythmogenic CAs, where the main treatment strategy consists of shock delivery, PEA is managed by diagnosis and treatment of the underlying cause. True PEA can thus be regarded as the final common pathway of pseudo PEA.Įven though prognosis has increased over the years, PEA still has an estimated 1-month survival of merely 4.9–6.8%. Eventually, with ongoing depletion and deterioration, myocardial contractions disappear completely, resulting in true PEA. If the underlying cause is not reversed, the heart continues to pump despite an ongoing depletion of oxygen and metabolic supplies. This is often caused by a severe shock state (such as hypovolemia or obstruction of cardiac output). This should however be differentiated from pseudo PEA in which some cardiac movement is still present although not powerful enough to produce adequate circulation. The heart is at a complete standstill despite a normal electrical rhythm. In true PEA, no cardiac movement can be detected. PEA is defined as the absence of a palpable pulse, even though the electrocardiogram (ECG) demonstrates a synchronized electrical rhythm. 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. 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. In Europe, annual incidences up to 119 per 100,000 adults have been reported. Sudden cardiac arrest (CA) is a leading cause of death in the Western world. Comparative studies are required to identify the best ultrasonographic protocol, which can be included in resuscitation guidelines. Ultrasonographic evaluation should be performed subsequently, both for detecting an underlying cause and discriminating between true PEA and pseudo PEA. In the management of OHCA, anamnestic and clinical information remains the initial source of information in search for an underlying cause. Although evidence about the prognostic potential of cerebral oximetry in OHCA is accumulating, its diagnostic potential is still unknown. Multiple studies describe a prognostic potential. Limited evidence suggests a role for point-of-care testing in detecting hyperkalemia and a role for capnography in the diagnosis of asphyxia CA. Further research concerning the relationship between electrocardiogram characteristics and underlying causes is required. There are currently no studies comparing these protocols regarding their feasibility and their effect on patient survival. Ultrasonography has become a great asset in detecting underlying causes, and a variety of protocols have been proposed. Articles were assessed for eligibility by title, abstract, and full text. A systematic literature search of the PubMed database was performed. The aim of this study was to review the diagnostic tools available in a prehospital setting, and their interpretation during cardiac arrest (CA) with PEA as initial rhythm. This often poses a challenge in the chaotic prehospital environment with only limited resources available. PEA should be managed by identifying the underlying cause of the arrest and treating it accordingly. The proportion of out-of-hospital cardiac arrests (OHCAs) with pulseless electrical activity (PEA) as initial rhythm is increasing.
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