Pulseless Electrical Activity (PEA) ECG Example
Figure 1: Pulseless Electrical Activity (PEA) - Characteristic ECG Pattern
🔑 Key Points at a Glance
- Heart Rate: Variable electrical activity without mechanical pulse
- Primary Significance: Cardiac arrest rhythm, requires CPR and treatment of reversible causes (H's and T's)
- Key Management: High-quality CPR, identify and treat reversible causes (hypovolemia, hypoxia, H+, hypo/hyperkalemia, hypothermia, toxins, tamponade, tension pneumo, thrombosis, trauma)
- Clinical Category: Clinical
Overview and Clinical Significance
Pulseless Electrical Activity (PEA) represents a critical cardiac rhythm pattern that requires immediate recognition and intervention. Cardiac arrest rhythm, requires CPR and treatment of reversible causes (H's and T's)
Understanding this ECG finding is essential for emergency physicians, cardiologists, intensivists, and all healthcare providers involved in acute cardiac care. Early recognition and appropriate management can significantly impact patient outcomes and prevent life-threatening complications.
ECG Characteristics and Recognition
📊 Diagnostic ECG Criteria
- Organized electrical rhythm on monitor
- No palpable pulse
- No cardiac output
- Variable QRS morphology depending on underlying rhythm
Systematic ECG Analysis Approach
When analyzing any ECG, including suspected Pulseless Electrical Activity (PEA), follow this systematic approach:
- Rate: Calculate ventricular rate using the 300-150-100-75-60-50 rule or count QRS complexes in 6 seconds × 10
- Rhythm: Assess regularity by measuring R-R intervals across the entire strip
- P Waves: Identify presence, morphology, and relationship to QRS complexes
- PR Interval: Measure from start of P wave to start of QRS (normal: 0.12-0.20 seconds or 3-5 small squares)
- QRS Complex: Assess duration (normal: Always assess hemodynamic stability FIRST - unstable patients require immediate intervention regardless of the specific ECG diagnosis
Evidence-Based Management
Acute Management Strategy
Primary Treatment Approach: High-quality CPR, identify and treat reversible causes (hypovolemia, hypoxia, H+, hypo/hyperkalemia, hypothermia, toxins, tamponade, tension pneumo, thrombosis, trauma)
🚨 Emergency Protocol - Time-Critical Actions
- Immediate ABC assessment (Airway, Breathing, Circulation)
- Attach continuous cardiac monitoring and obtain 12-lead ECG
- Establish large-bore IV access (×2) and check bedside glucose
- Administer supplemental oxygen if SpO₂ Recommendations for management of Pulseless Electrical Activity (PEA) are primarily supported by Level A evidence (multiple high-quality randomized controlled trials and meta-analyses).
Summary and Clinical Bottom Line
📋 Clinical Bottom Line
Pulseless Electrical Activity (PEA) is characterized by organized electrical rhythm on monitor on ECG. Cardiac arrest rhythm, requires CPR and treatment of reversible causes (H's and T's) Primary management: High-quality CPR, identify and treat reversible causes (hypovolemia, hypoxia, H+, hypo/hyperkalemia, hypothermia, toxins, tamponade, tension pneumo, thrombosis, trauma) Key takeaway: This is a life-threatening emergency requiring immediate recognition and treatment - time-critical intervention saves lives
About the Author
Dr. Raj K
Emergency Medicine Physician Dr. Raj K is a board-certified Emergency Medicine physician with extensive experience in acute cardiac emergencies, advanced ECG interpretation, and critical care. He is passionate about medical education and bringing evidence-based emergency medicine knowledge to healthcare providers worldwide through E-PulsePoints. His clinical expertise includes STEMI management, complex arrhythmia recognition, and emergency cardiac procedures.
