Pulseless Electrical Activity Medication

  • Author: Sandy N Shah, DO, MBA, FACC, FACOI; Chief Editor: Jeffrey N Rottman, MD   more...
 
Updated: Dec 16, 2011
 

Medication Summary

Inotropic, anticholinergic, and alkalinizing agents are used in the treatment of pulseless electrical activity (PEA). As previously stated, resuscitative pharmacology includes epinephrine, vasopressin, and atropine. Vasopressin may replace either the first or second dose of epinephrine in patients with PEA. If the underlying rhythm is bradycardia (ie, heart rate < 60 bpm) associated with hypotension, then atropine should be administered. Sodium bicarbonate may be administered only in patients with severe, systemic acidosis, hyperkalemia, or a tricyclic antidepressant overdose.

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Inotropic Agents

Class Summary

Inotropic agents increase the central aortic pressure and counter myocardial depression. Their main therapeutic effects are cardiac stimulation, bronchial smooth muscle relaxation, and dilatation of skeletal muscle vasculature.

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Epinephrine (Adrenalin)

 

Epinephrine has alpha-agonist effects that include increased peripheral vascular resistance and reversed peripheral vasodilatation, systemic hypotension, and vascular permeability. Beta-agonist effects of epinephrine include bronchodilatation, chronotropic cardiac activity, and positive inotropic effects.

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Anticholinergic Agents

Class Summary

Anticholinergic agents improve conduction through the atrioventricular (AV) node by reducing vagal tone via muscarinic receptor blockade.

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Atropine IV/IM (Isopto)

 

Atropine is used for the treatment of bradyarrhythmias. It works to increase heart rate through vagolytic effects, causing increase in cardiac output. Total vagolytic dose is 2 mg; doses of under 0.5 mg may exacerbate bradycardia

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Alkalinizing Agents

Class Summary

These are useful in the alkalinization of urine. Routine administration of sodium bicarbonate is discouraged because it worsens intracellular and intracerebral acidosis and is not proven to reduce mortality rate.

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Sodium bicarbonate (Neut)

 

Sodium bicarbonate is used only when the patient is diagnosed with bicarbonate-responsive acidosis, hyperkalemia, or tricyclic antidepressant or phenobarbital overdose. Routine use is not recommended.

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Contributor Information and Disclosures
Author

Sandy N Shah, DO, MBA, FACC, FACOI,  Cardiologist, Houston, Texas

Sandy N Shah, DO, MBA, FACC, FACOI, is a member of the following medical societies: American College of Cardiology, American College of Osteopathic Internists, and American Osteopathic Association

Disclosure: Nothing to disclose.

Coauthor(s)

Patrick O'Beirne, MD  Fellow in Cardiovascular Medicine, University of Massachusetts 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.

Dionyssios A Robotis, MD, MPH, FACC  Clinical Associate Professor of Medicine, University of Massachusetts Medical School; 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, FACC, FHRS  Associate Professor of Medicine, Director, Section of Cardiac Pacing and Electrophysiology, Director of EP Fellowship Program, Division of Cardiovascular Disease, University of Massachusetts Memorial Medical Center

Lawrence Rosenthal, MD, PhD, FACC, FHRS is a member of the following medical societies: American College of Cardiology, American Heart Association, and Massachusetts Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Jeffrey N Rottman, MD  Professor of Medicine and Pharmacology, 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.

Additional Contributors

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, American Heart Association, American Medical Association, and Heart Rhythm Society

Disclosure: Nothing to disclose.

David S Marks, MD Director of Cardiac Catheterization Laboratory, Froedtert Memorial Lutheran Hospital; Associate Professor, Department of Internal Medicine, Section of Cardiology, Medical College of Wisconsin

David S Marks, MD is a member of the following medical societies: American College of Cardiology, American Heart Association, American Medical Association, Medical Association of Georgia, and Society for Cardiac Angiography and Interventions

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Eric Vanderbush, MD, FACC Chief, Department of Internal Medicine, Division of Cardiology, Harlem Hospital Center; Clinical Assistant Professor of Cardiology, Columbia University College of Physicians and Surgeons

Eric Vanderbush, MD, FACC is a member of the following medical societies: American College of Cardiology and American Heart Association

Disclosure: Nothing to disclose.

Sumit Verma, MD, FACC Staff Electrophysiologist, Cardiology Consultants, Pensacola Heart Institute

Sumit Verma, MD, FACC is a member of the following medical societies: American College of Cardiology

Disclosure: Nothing to disclose.

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