Pulseless electrical activity classification: Difference between revisions

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Latest revision as of 21:25, 18 December 2013

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Karol Gema Hernandez, M.D. [2]

Overview

PEA can be classified as cardiac and non cardiac depending on the initial underlying etiology. Cardiac PEA can be further classified as primary and secondary to a preceding ventricular tachycardia or ventricular fibrillation.^[1] Pulseless electrical activity can be classified either by the intensity of cardiac contractions or their electrical manifestations (true or psuedo PEA). There can be found different electrocardiographic patterns in each of the electrical manifestations classification.^[2] There is also one type of pulseless electrical activity seen in a post- shock EKG, which should not be classified, and therefore approached as a true PEA.

Classification

EKG Patterns

According to waveform morphology PEA can be classified from a normal QRS width, with isolectric ST and P waves, to waveforms beyond QRS, P and T wave recognition. Waveform analysis has been studied for ultimately predict treatment outcomes, specially regarding ROSC (return of spontaneous circulation) as the final goal. In a study made by Dragsund et al in Norway, they mainly studied waveforms for ventricular fibrillation but they hypothesize that the outcome may be similar for PEA. They suggest that PEA waveforms can be categorized quantitatively depending on the rhythm they spontaneously transformed to before they transitioned to either ROSC or asystole.

Classification by Intensity of Cardiac Contractions

True PEA

There are no cardiac contractions despite electrical activity.

Pseudo PEA

There are very weak cardiac contractions present that fail to generate a blood pressure compatible with systemic perfusion and life despite electrical activity. Pseudo PEA is characterized by narrow QRS complexes, short RR intervals, and a faster rate than true PEA. Pseudo PEA has been associated with a better response to treatment compared to true PEA.

Post Defibrillation PEA

Following defibrillation, there can be a period of electromechanical dissociation where electrocardiographic complexes do not generate a pulse. Post defibrillator PEA can result either from myocardial injury or from the termination of the ventricular tachycardia or ventricular fibrillation.^[1] As a result of post defibrillation PEA, it is often useful to continue CPR for up to one minute following restoration of a perfusing rhythm.

References

↑ ^1.0 ^1.1 Myerburg RJ, Halperin H, Egan DA, Boineau R, Chugh SS, Gillis AM; et al. (2013). "Pulseless electric activity: definition, causes, mechanisms, management, and research priorities for the next decade: report from a national heart, lung, and blood institute workshop". Circulation. 128 (23): 2532–41. doi:10.1161/CIRCULATIONAHA.113.004490. PMID 24297818.
↑ {{Dragsund, I, K Gundersen, M Risdal, J Kramer-Johansen, D Edelson, F Sterz, and T Eftestøl. "Analysing the dynamics of pulseless electrical activity during cardiopulmonary resuscitation." Computers in cardiology, 2006 17-20 Sept. 2006, [Valencia, Spain. Piscataway, N.J.: IEEE Xplore, 2008. 749 - 752. Print.}}

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[pmid24297818-1] 1.0 ^1.1 Myerburg RJ, Halperin H, Egan DA, Boineau R, Chugh SS, Gillis AM; et al. (2013). "Pulseless electric activity: definition, causes, mechanisms, management, and research priorities for the next decade: report from a national heart, lung, and blood institute workshop". Circulation. 128 (23): 2532–41. doi:10.1161/CIRCULATIONAHA.113.004490. PMID 24297818.

[2] {{Dragsund, I, K Gundersen, M Risdal, J Kramer-Johansen, D Edelson, F Sterz, and T Eftestøl. "Analysing the dynamics of pulseless electrical activity during cardiopulmonary resuscitation." Computers in cardiology, 2006 17-20 Sept. 2006, [Valencia, Spain. Piscataway, N.J.: IEEE Xplore, 2008. 749 - 752. Print.}}

[1]

[2]

@@ Line 6: / Line 6: @@
 |}
 {{Pulseless electrical activity}}
-{{CMG}}
+{{CMG}}; {{AE}} {{KGH}}
+==Overview==
+PEA can be classified as cardiac and  non cardiac depending on the initial underlying etiology.  Cardiac PEA can be further classified as primary and secondary to a preceding ventricular tachycardia or ventricular fibrillation.<ref name="pmid24297818">{{cite journal| author=Myerburg RJ, Halperin H, Egan DA, Boineau R, Chugh SS, Gillis AM et al.| title=Pulseless electric activity: definition, causes, mechanisms, management, and research priorities for the next decade: report from a national heart, lung, and blood institute workshop. | journal=Circulation | year= 2013 | volume= 128 | issue= 23 | pages= 2532-41 | pmid=24297818 | doi=10.1161/CIRCULATIONAHA.113.004490 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24297818  }} </ref>  Pulseless electrical activity can be classified either by the intensity of cardiac contractions or their electrical manifestations (true or psuedo PEA). There can be found different electrocardiographic patterns in each of the electrical manifestations classification.<ref> {{Dragsund, I, K Gundersen, M Risdal, J Kramer-Johansen, D Edelson, F Sterz, and T Eftestøl. "Analysing the dynamics of pulseless electrical activity during cardiopulmonary resuscitation." Computers in cardiology, 2006 17-20 Sept. 2006, [Valencia, Spain. Piscataway, N.J.: IEEE Xplore, 2008. 749 - 752. Print.}} </ref>  There is also one type of pulseless electrical activity seen in a post- shock EKG, which should not be classified, and therefore approached as a true PEA.
 ==Classification==
-===True PEA===
+===EKG Patterns===
+According to waveform morphology PEA can be classified from a normal QRS width, with isolectric ST and P waves, to waveforms beyond QRS, P and T wave recognition. Waveform analysis has been studied for ultimately predict treatment outcomes, specially regarding ROSC (return of spontaneous circulation) as the final goal. In a study made by Dragsund et al in Norway, they mainly studied waveforms for [[ventricular fibrillation]] but they hypothesize that the outcome may be similar for PEA. They suggest that PEA waveforms can be categorized quantitatively depending on the rhythm they spontaneously transformed to before they transitioned to either ROSC or asystole.
+===Classification by Intensity of Cardiac Contractions===
+====True PEA====
 There are no cardiac contractions despite electrical activity.
-===Pseudo PEA===
+====Pseudo PEA====
-There are very weak cardiac contractions present that fail to generate a blood pressure compatible with systemic perfusion and life despite electrical activity.
+There are very weak cardiac contractions present that fail to generate a blood pressure compatible with systemic perfusion and life despite electrical activity.  Pseudo PEA is characterized by narrow [[QRS complex]]es, short RR intervals, and a faster rate than true PEA.  Pseudo PEA has been associated with a better response to treatment compared to true PEA.
 ===Post Defibrillation PEA===
-Following defibrillation, there can be a period of electromechanical dissociation where electrocardiographic complexes do not generate a pulse.  As a result of post defibrillation PEA, it is often useful to continue CPR for up to one minute following restoration of a perfusing rhythm.
+Following defibrillation, there can be a period of electromechanical dissociation where electrocardiographic complexes do not generate a pulse.  Post defibrillator PEA can result either from myocardial injury or from the termination of the ventricular tachycardia or ventricular fibrillation.<ref name="pmid24297818">{{cite journal| author=Myerburg RJ, Halperin H, Egan DA, Boineau R, Chugh SS, Gillis AM et al.| title=Pulseless electric activity: definition, causes, mechanisms, management, and research priorities for the next decade: report from a national heart, lung, and blood institute workshop. | journal=Circulation | year= 2013 | volume= 128 | issue= 23 | pages= 2532-41 | pmid=24297818 | doi=10.1161/CIRCULATIONAHA.113.004490 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24297818  }} </ref>  As a result of post defibrillation PEA, it is often useful to continue CPR for up to one minute following restoration of a perfusing rhythm.
 ==References==