Ultrasound in PEA

January 17, 2018

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Patients in PEA arrest with organized cardiac activity on bedside ultrasound appear to have better survival than those with disorganized, agonal cardiac activity and may respond to treatments not usually performed in standard ACLS, like continuous vasoactive drips during arrest.

Why does this matter?
Ultrasound may be helpful in arrest.  In patients down for an extended period of time with no cardiac activity on bedside ultrasound, the prognosis is grim.  This study looked specifically at the role of bedside ultrasound in PEA.

Two PEAs in A-pod
This was a retrospective analysis of patients with PEA who received bedside ultrasound while performing pulse checks during resuscitation efforts.  They found that patients with organized (contractile) cardiac activity had better survival to hospital admission than those with agonal (twitching) cardiac activity, 40% vs 15% respectively.  Overall survival to discharge was abysmal across the board, with only 2/75 survivors with organized activity vs 1/95 with disorganized.  The authors noted that those who had organized activity and were on continuous IV drips (mostly dopamine or norepinephrine) seemed to do a little better than those not on drips.  Because the numbers are so small, this study is only hypothesis-generating.  It does raise the question though: are patients with PEA and organized cardiac activity a different group and need to be treated off standard ACLS protocol?  Is it that they have some forward blood flow but so weak that no pulse is palpable? Therefore, might they respond to more aggressive treatment, like volume, continuous pressor infusion, transfusion (if acute blood loss), etc?  For me, the take home is that PEA still does poorly, but those with organized cardiac activity may be a subgroup that may benefit by departing from standard ACLS protocols.

Source
A retrospective study of pulseless electrical activity, bedside ultrasound identifies interventions during resuscitation associated with improved survival to hospital admission. A REASON Study.  Resuscitation. 2017 Nov;120:103-107. doi: 10.1016/j.resuscitation.2017.09.008. Epub 2017 Sep 13.

Peer reviewed by Thomas Davis, MD.