Pulseless Electrical Activity Differential Diagnoses

Updated: Nov 28, 2017
  • Author: Sandy N Shah, DO, MBA, FACC, FACP, FACOI; Chief Editor: Jose M Dizon, MD  more...
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Diagnostic Considerations

In out-of-hospital pulseless electrical activity (PEA) cardiac arrests, Ho et al reported that characteristics of presenting prehospital electrocardiograms (ECGs) do not appear to be prognostic for survival to hospital discharge (SHD) or return of spontaneous circulation (ROSC) and therefore should not be used to guide termination of resuscitation. [19]  Prognostic factors included location of arrest for SHD, as well as advanced life support paramedics on scene and successful intubation for ROSC. Atropine use was a negative predictor for SHD and for ROSC. [19]

There are ongoing attempts at developing automatic methods for retrospective data analysis of cardiac rhythms in resuscitation episodes. Unfortunately, although they appear to be successful at automaticaly classifying resuscitation cardiac rhythms, their accuracy and sensitivity for PEA and/or pulse-generating rhythm have been low. [20, 21]

Differential Diagnoses