This condition is actually fairly common, and is the initial rhythm in up to 35% of in-hospital cardiac arrests. PEA is more common in women, and ventilated patients. Beta blockers and calcium channel blocker use may contribute to PEA. There is a clear, independent link between antipsychotic medications and PEA. The more abnormal the presenting EKG, the worse the outcome. Patients with a wide QRS do more poorly.
Hypoxia is perhaps the most common contributor to PEA- with as many as 50% of PEA cases stemming from respiratory failure.
The American Heart Association lists common causes of PEA in the H's and T's mnemonic.
Metabolic disturbances are not considered primary causes of PEA, although they can be contributing factors. Issues such has acidosis compound the problem and tend to progress as the condition continues during a code.
Desbiens devised a "3 and 3" rule to allow easy recollection of common causes of PEA. The rule organizes the causes into 3 major ones:
- 1)Severe hypovolemia- from hemorrhage or trauma.
- 2) Pump failure- massive MI or severe heart failure.
- 3)Obstruction to circulation- from one of the below causes:
- b) Cardiac tamponade
- c) Massive pulmonary embolus
Desbiens NA. Simplifying the diagnosis and management of pulseless electrical activity in adults: a qualitative review. Crit Care Med. Feb 2008;36(2):391-6.