eMedicine Specialties > Cardiology > Arrhythmias

Pulseless Electrical Activity: Follow-up

Author: Patrick O'Beirne, MD, Fellow in Cardiovascular Medicine, UMass Memorial Medical Center
Coauthor(s): Dionyssios A Robotis, MD, MPH, FACC, Assistant Professor of Medicine, University of Massachusetts; Consulting Staff Cardiologist/Electrophysiologist, University of Massachusetts Memorial Medical Center; Lawrence Rosenthal, MD, PhD, Associate Professor of Medicine, Director, Section of Cardiac Electrophysiology and Pacing, Fellowship Director of Clinical Cardiac Electrophysiology, Department of Internal Medicine, Division of Cardiovascular Medicine, University of Massachusetts Memorial Medical Center
Contributor Information and Disclosures

Updated: May 11, 2009

Follow-up

Further Inpatient Care

Once resuscitation is successful, provide general care based on individual needs. Special care should be taken to adequately treat the initial problem that led to pulseless electrical activity.

Transfer

Some institutions may not have the capability to provide specialized care (eg, cardiac surgery, pulmonary embolectomy). Once stabilized, patients in these centers may be transferred to tertiary care centers for definitive care.

Deterrence/Prevention

The following measures may prevent some cases of in-hospital pulseless electrical activity:

  • Patients who have been on prolonged bed rest should receive deep venous thrombosis (DVT) prophylaxis.
  • Patients who are on ventilators should be monitored carefully for auto-PEEP development.
  • Hypovolemia should be treated aggressively, especially in patients with active bleeding.

Prognosis

  • The overall prognosis for patients with pulseless electrical activity is poor, unless a rapidly reversible cause is identified and corrected. Evidence suggests that ECG characteristics are related to the patient's prognosis. The more abnormal the ECG characteristics, the less likely the patient is to recover from pulseless electrical activity; patients with a wider QRS (>0.2 s) fare worse.
  • Interestingly, patients with out-of-hospital pulseless electrical activity are more likely to recover than patients who develop this condition in the hospital. In one study, 98 of 503 (19.5%) patients survived out-of-hospital pulseless electrical activity. This difference is likely because of different etiologies and severity of illness.
  • Patients who are not in the hospital are more likely to have reversible etiologies (eg, hypothermia).
  • Overall, pulseless electrical activity remains a poorly understood entity with a dismal prognosis. Reversing this otherwise lethal condition may be possible by aggressively seeking and promptly correcting reversible causes.

Patient Education

For excellent patient education resources, visit eMedicine's Public Health Center. Also, see eMedicine's patient education article Cardiopulmonary Resuscitation (CPR).

Miscellaneous

Medicolegal Pitfalls

Failure to obtain appropriate documentation during and after advanced cardiac life support procedures.

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Sumit Verma, MD, FACC and David S Marks, MD to the development and writing of this article.



More on Pulseless Electrical Activity

Overview: Pulseless Electrical Activity
Differential Diagnoses & Workup: Pulseless Electrical Activity
Treatment & Medication: Pulseless Electrical Activity
Follow-up: Pulseless Electrical Activity
References
Further Reading
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References

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Further Reading

Clinical guidelines

(1) ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to revise the 1999 guidelines for the Management of Acute Myocardial Infarction). (2) 2007 focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.
American College of Cardiology Foundation - Medical Specialty Society
American Heart Association - Professional Association.  1996 Nov 1 (revised 2004 Jul; addendum released 2008 Jan).  Original guideline: 211 pages; Focused update: 38.  NGC:006289

Cardiac arrhythmias in coronary heart disease. A national clinical guideline.
Scottish Intercollegiate Guidelines Network - National Government Agency [Non-U.S.].  2007 Feb.  40 pages.  NGC:005528
 
ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death).
American College of Cardiology Foundation - Medical Specialty Society
American Heart Association - Professional Association
European Heart Rhythm Association - Professional Association
European Society of Cardiology - Medical Specialty Society
Heart Rhythm Society - Professional Association.  2006 Sep 5.  100 pages.  NGC:005208

Resuscitation and defibrillation in the health care setting — 2004 revision & update.
American Association for Respiratory Care - Professional Association.  1993 Dec (revised 2004 Sep).  15 pages.  NGC:004081

Clinical trials

 SmartCPR Trial: An Analysis of a Waveform-Based Automated External Defibrillation (AED) Algorithm on Survival From Out-of-Hospital Ventricular Fibrillation

Pre-Shock Cardiopulmonary Resuscitation to Patients With Out-of-Hospital Resuscitation, A Randomised Clinical Trial

Efficacy of Methylprednisolone for Hantavirus Cardiopulmonary Syndrome

Related eMedicine topics

 Asystole (Emergency Medicine)

Ventricular Fibrillation (Cardiology)

Ventricular Fibrillation (Emergency Medicine)

Ventricular Fibrillation (Pediatrics)

Cardiopulmonary Resuscitation (CPR) (Procedures)

Therapeutic Hypothermia (Procedures)

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Keywords

pulseless electrical activity, electromechanical dissociation, cardiopulmonary resuscitation, CPR, advanced cardiac life support, ACLS, cardia arrest, treatment, symptoms, cardiac arrhythmia, cardiac contractions, ventricular mechanical activity, ventricular electrical activity, EMD, PEA, pseudo-PEA

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Contributor Information and Disclosures

Author

Patrick O'Beirne, MD, Fellow in Cardiovascular Medicine, UMass Memorial Medical Center
Patrick O'Beirne, MD is a member of the following medical societies: American College of Cardiology, American Medical Association, Massachusetts Medical Society, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Coauthor(s)

Dionyssios A Robotis, MD, MPH, FACC, Assistant Professor of Medicine, University of Massachusetts; Consulting Staff Cardiologist/Electrophysiologist, University of Massachusetts Memorial Medical Center
Dionyssios A Robotis, MD, MPH, FACC is a member of the following medical societies: American College of Cardiology, Cardiac Electrophysiology Society, Heart Rhythm Society, and Massachusetts Medical Society
Disclosure: Nothing to disclose.

Lawrence Rosenthal, MD, PhD, Associate Professor of Medicine, Director, Section of Cardiac Electrophysiology and Pacing, Fellowship Director of Clinical Cardiac Electrophysiology, Department of Internal Medicine, Division of Cardiovascular Medicine, University of Massachusetts Memorial Medical Center
Lawrence Rosenthal, MD, PhD is a member of the following medical societies: American College of Cardiology, American Heart Association, Heart Rhythm Society, and Massachusetts Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Eric Vanderbush, MD, FACC, MD, Chief, Department of Internal Medicine, Division of Cardiology, Clinical Assistant Professor, Harlem Hospital Center and Columbia University
Eric Vanderbush, MD, FACC, MD is a member of the following medical societies: American College of Cardiology and American Heart Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Steven J Compton, MD, FACC, FACP, Director of Cardiac Electrophysiology, Alaska Heart Institute, Providence and Alaska Regional Hospitals
Steven J Compton, MD, FACC, FACP is a member of the following medical societies: Alaska State Medical Association, American College of Cardiology, American College of Physicians, and Heart Rhythm Society
Disclosure: Nothing to disclose.

CME Editor

Amer Suleman, MD, Consultant in Electrophysiology and Cardiovascular Medicine, Department of Internal Medicine, Division of Cardiology, Medical City Dallas Hospital
Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

Chief Editor

Jeffrey N Rottman, MD, Professor of Medicine and Pharmacology, Director, Clinical Cardiac Electrophysiology Fellowship Program, Vanderbilt University School of Medicine; Chief, Department of Cardiology, Nashville Veterans Affairs Medical Center
Jeffrey N Rottman, MD is a member of the following medical societies: American Heart Association and North American Society of Pacing and Electrophysiology (NASPE)
Disclosure: Nothing to disclose.

 
 
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