Wednesday, December 11, 2019

Pseudo PEA in the ED

St Emlyn's - December 10, 2019 - By pete Hulme
..."What is Pseudo-PEA and how does it differ from ‘true’ PEA?
-True PEA is the presence of organized electrical activity on cardiac monitor without a palpable pulse and no cardiac motion on POCUS.
-Pseudo-PEA is organized electrical activity on cardiac monitor without a pulse but with cardiac motion on point of care ultrasound (POCUS).
What’s the bottom line?
It’s really important to differentiate pseudo-PEA from true-PEA because ROSC and survival rates are higher in pseudo-PEA.
The evidence for the different management options vasopressin and CPR synchronised to systole are limited but make sense physiologically and would be important areas for future research. Indeed a further paper looking at synchronous CPR in pigs has just been published showing further promise.
POCUS should be a core skill for all emergency physicians and will help us make a diagnosis of pseudo-PEA.
True PEA has a worse prognosis than pseudo-PEA so diagnosing that may aid decision making in cessation of cardiac arrest.
42-86% of all PEA is pseudo-PEA. As this is more common than people probably realise more research should be done in this area to try to improve outcomes for patients. (Salen et al)"