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 Cardiac 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 cardiac arrest algorithm diagram. When done click again to close the
diagram. Cardiac 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 emergency
progresses. 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.