Pulseless electrical activity historical perspective
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Overview
Pulseless electrical activity as the main approach for sudden cardiac arrest (SCA) was not completely studied until the middle of the 1980's. The explanation for this, is that ventricular fibrillation (VF) and ventricular tachycardia (VT), were the main causes for the morbidity and mortality of SCA. However there has been a change in approaching the causes of SCA, pointing to PEA as the initial rhythm leading to SCA.
Historical Perspective
The first approach against trying to decrease mortality due to SCA, was to target tachyarrhythmias, especially ventricular fibrillation (VF) and ventricular tachycardia (VT). This was mainly achieved by the improvements in CPR techniques, the availability of defibrillators to lay responders and the use of implantable cardioverter- defibrillators. Nevertheless, there is and increase in prevalence of PEA and asystolia, which makes them now more frequent than VT and VF. There is still not clear if this can be due to a proportional increase, rather than an absolute increase in cases of PEA. Studies suggest that there is a need to change this approach, because of the increased proportion of PEA cases, and mainly because of the better outcomes for survival in PEA patients, than those with VF/VT [1] [2]. Deeper studies will achieve ultimately a better therapeutic strategy, leading to better patient outcomes and a subsequent impact in overall mortality due to SCA.
There was a workshop created by Myerburg from a National Heart, Lung, and Blood Institute [2] as an attempt to record the current knowledge and direct the future research in the field. This workshop also described some of the pathophysiology of PEA, which may translate to improved clinical care.
References
- ↑ Teodorescu C, Reinier K, Dervan C, Uy-Evanado A, Samara M, Mariani R; et al. (2010). "Factors associated with pulseless electric activity versus ventricular fibrillation: the Oregon sudden unexpected death study". Circulation. 122 (21): 2116–22. doi:10.1161/CIRCULATIONAHA.110.966333. PMID 21060069.
- ↑ 2.0 2.1 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.