Pediatric Advance Life Support: Pulseless Electrical Activity (PEA)

Pediatric Non-profusing Rhythms

·         Pulseless electrical activity

·         Asystole

·         Agonal Rhythms

·         Ventricular tachycardia

·         Ventricular fibrillation

Examples of PEA rhythms

Idioventricular rhythm

Hyperkalemia

Sinus Arrest

Supraventricular tachycardia secondary to hypovolemia

Sinus bradycardia secondary to hypoxia

Cardiac arrest in infants and children

·         Does not usually result from a primary cardiac cause

·         Terminal result of progressive respiratory failure or shock

·         Asphyxia begins

·         Period of systemic hypoxemia, hypercapnia, and acidosis

·         Progresses to bradycardia and hypotension

·         Culminates with cardiac arrest

Pulseless Electrical Activity

·         Displays a rhythm on the monitor but does not have an arterial pulse

·         Confirm pulselessness with doppler

·         Key to treatment is early identification of possible causes

·         Outcome is very poor unless the cause can be established and treated

Note:  The most common ECG findings in infants and children in cardiac arrest are asystole and PEA. PEA is organized electrical activity—most commonly slow, wide QRS complexes—without palpable pulses. Pulseless electrical activity (PEA), in which electrical activity is visible on the electrocardiogram but central pulses are absent (previously referred to as EMD)

Children with pulseless electrical activity are apneic with absent pulses and signs of poor perfusion. The electrocardiogram shows organized electrical activity, although no pulses are present. The outcome from PEA is very poor unless the cause can be established and treated

PEA mnemonic:  Keep them ALIVE

Assess ABCs

Listen for pulse using doppler

Initiate CPR

Vasoconstrictors

Evaluate reversable causes