Pulseless electrical activity natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Karol Gema Hernandez, M.D. [2]
Overview
PEA is associated with a poor prognosis, particularly if the underlying cause is not readily identifiable and treated. The presence of a QRS interval > 0.20 seconds is associated with a poorer prognosis. The survival of in hospital PEA is only 11.2%.[1] The survival for out of hospital occurrence of PEA is higher (19.5%) than for in hospital PEA, likely due to the higher incidence of reversible causes among patients with out of hospital arrest. The survival of PEA as a presenting rhythm is poorer than ventricular tacycardia or ventricular fibrillation.[2]
Prognosis
In a study made by Nadkarni et al in 11,963 patients with PEA, only 11% survived, and of these 62% had good neurological outcomes [1]. Zoch et al in another study reported that no patients older than 80 years, or that had an witnessed event survived [3] . Resuscitation Outcomes Consortium stated that patient survival after treated PEA during hospitalization is 8%, compared to 30.5% for VT/VF arrests, showing the great importance of strategies for improving survival after PEA due to SCA. However, Kudenchuk et al demonstrated an increase in overall survival from 2000 to 2004 with an odds ratio of 1.51 at 1 month (95% confidence interval [CI], 1.07–2.11), and 1.90 at 1 year (95% CI, 1.27–2.85) [4].
According to Kudenchuk et al this increase in survival is attributed to the improvement of CPR techniques. However, this change in prevalence is unlikely because of improvement of response times. There are studies with different results, regarding response time. In the OPALS study (Ontario Prehospital Advanced Life Support) the increase of PEA cases occurred in a period of years where response times decreased [5]. A study made in Sweden by Herlitz et al, point out that the decrease in response timed correlated with the decrease of VT/VF and the increase of PEA. Teodorescu et al found no significant differences in response times between VF/VT, PEA, and asystolia [6].
References
- ↑ 1.0 1.1 Nadkarni VM, Larkin GL, Peberdy MA, Carey SM, Kaye W, Mancini ME, Nichol G, Lane-Truitt T, Potts J, Ornato JP, Berg RA (2006). "First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults". JAMA : the Journal of the American Medical Association. 295 (1): 50–7. doi:10.1001/jama.295.1.50. PMID 16391216. Retrieved 2012-09-16. Unknown parameter
|month=ignored (help) - ↑ Meaney PA, Nadkarni VM, Kern KB, Indik JH, Halperin HR, Berg RA (2010). "Rhythms and outcomes of adult in-hospital cardiac arrest". Critical Care Medicine. 38 (1): 101–8. doi:10.1097/CCM.0b013e3181b43282. PMID 19770741. Retrieved 2012-09-16. Unknown parameter
|month=ignored (help) - ↑ Zoch TW, Desbiens NA, DeStefano F, Stueland DT, Layde PM (2000). "Short- and long-term survival after cardiopulmonary resuscitation". Arch Intern Med. 160 (13): 1969–73. PMID 10888971.
- ↑ Kudenchuk PJ, Redshaw JD, Stubbs BA, Fahrenbruch CE, Dumas F, Phelps R; et al. (2012). "Impact of changes in resuscitation practice on survival and neurological outcome after out-of-hospital cardiac arrest resulting from nonshockable arrhythmias". Circulation. 125 (14): 1787–94. doi:10.1161/CIRCULATIONAHA.111.064873. PMID 22474256.
- ↑ Stiell IG, Wells GA, Field BJ, Spaite DW, De Maio VJ, Ward R; et al. (1999). "Improved out-of-hospital cardiac arrest survival through the inexpensive optimization of an existing defibrillation program: OPALS study phase II. Ontario Prehospital Advanced Life Support". JAMA. 281 (13): 1175–81. PMID 10199426.
- ↑ 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.