Pulseless electrical activity classification
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Pulseless electrical activity can be classified either by the intensity of cardiac contractions or their electrical manifestations (true or psuedo PEA), and by electrocardiographic features. These three can overlap and ultimately be classified by the electrical manifestations, and having different electrocrdiographic patterns in each of them. 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.It has narrow QRS complexes, short RR intervals, and a higher rate than true PEA. It has also been proved to have better response to treatment.
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.