PEA and Asystole Overview for Medical Professionals

Pulseless Electrical Activity (PEA) and Asystole Overview

• PEA is characterized by any organized rhythm without a pulse, displaying QRS complexes that are similar but may vary in rate and regularity.
• Commonly reversible causes of PEA include hypovolemia and hypoxia.

Epinephrine Administration

• The proper dosing regimen for epinephrine in PEA or asystole is 1 mg administered IV/IO, repeated every 3 to 5 minutes.

ECG Interpretation

• An isoelectric ECG (flatline) might result from factors such as loose leads, lack of power to the monitor, or inadequate gain/amplitude settings.

Resuscitation Efforts

• Rigor mortis and clear do-not-attempt-resuscitation (DNAR) status are valid reasons to stop resuscitative efforts.
• Continuous efforts even after 20 minutes without success are grounded in clinical judgment, not strict time limits.

Advanced Airway Management

• In asystole, advanced airway insertion should be considered only if bag-mask ventilation is insufficient, prioritizing ventilation effectiveness over IV/IO access.

Amiodarone Use in PEA

• Amiodarone is not indicated for PEA; its use is reserved for ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT).

Treatment Protocols for PEA

• Treatment of PEA extends beyond standard algorithm interventions; healthcare providers must actively seek and address underlying causes for successful resuscitation.

Defibrillation in Asystole

• There is no evidence supporting the efficacy of defibrillation for asystole; attempts to shock are discouraged unless distinguishing between fine VF and asystole is necessary.

Rhythm Classification

• PEA and asystole are classified as non-shockable rhythms, which guides treatment approaches and interventions.