Fast PEA | Slow PEA - Survival Difference

Spoon Feed
There is a difference between PEA rhythms.  Slow rates of electrical activity had the usual dismal prognosis.  But those with electrical rates >60 had survival and favorable neurological outcome comparable to VF/VT, 22% and 15% respectively.

Why does this matter?
Terminating resuscitation is difficult.  Patients in PEA present a greater challenge.  They can suddenly spring back to life after discontinuing resuscitative efforts - the so called Lazarus phenomenon.  But are all PEA rhythms created equal?

Mind your PEAs and Qs
504 PEA patients were stratified by electrical rate.  All quartiles < 60 were associated with higher mortality than those >60.  Quartiles of rate: 10-24 bpm, 25-39 bpm, 40-59, and >60 were fairly equal for known confounders for survival, such as bystander CPR, witnessed collapse, etc.  Survival at 30 days was 22% (16/73) with a rate >60; 2% (2/109) with a rate 10-24 bpm.  Good neurological outcome was 15% (11/73) for rate >60 bpm; 0% (0/109) for rate 10-24 bpm.  It appears not all PEAs are created equal, and this should factor into termination of resuscitation guidelines.

Source
Initial electrical frequency predicts survival and neurological outcome in out of hospital cardiac arrest patients with pulseless electrical activity.  Resuscitation. 2018 Feb 3;125:34-38. doi: 10.1016/j.resuscitation.2018.01.041. [Epub ahead of print]

Peer reviewed by Thomas Davis, MD.

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