Simplifying the diagnosis and management of pulseless electrical activity in adults: a qualitative review.

OBJECTIVE: The algorithms provided for advanced cardiac life support by the American Heart Association and the European Resuscitation Council Guidelines for Resuscitation for the diagnosis and treatment of pulseless electrical activity (PEA) correctly stress the importance of searching for potentially treatable causes, and suggest contributing factors that should be considered. This study sought evidence to support the factors that they mention in the algorithms.

DATA SOURCE: Human and animal studies in MEDLINE.

STUDY SELECTION: Putative causes of PEA along with the string "AND (PEA OR pulseless electrical activity OR electromechanical dissociation OR EMD)".

DATA EXTRACTION: Human studies documenting association and causation.

DATA SYNTHESIS: Qualitative.

CONCLUSIONS: Documentation for most putative causes is weak. Based on current documentation, a simplified rule is offered to direct resuscitators to treatable precipitants of PEA. It emphasizes the documented causes of PEA, has good pedagogical qualities, guides treatment, and is testable. Studies need to be performed to identify the best diagnostic and treatment strategies for PEA.