Imagine, someone in front of you suddenly loses consciousness and falls to the ground. You run around frantically, checking their neck for a pulse, but there's no pulse. They're not even breathing. You think this is cardiac arrest. But surprisingly, when they take them to the hospital, the doctors take an ECG and it shows electrical activity in the heart. There's electricity, but the heart isn't beating. This strange, dangerous condition is what we in medicine call "Pulseless Electrical Activity." We call it PEA for short. This is a very emergency situation. So, let's talk about it simply.
Simply put, what is PEA?
PEA is a type of cardiac arrest. What happens here is that, although there is electrical activity in the heart, the heart muscle does not contract and pump blood according to that electrical signal. It is like the light bulb not turning on because the filament has burned out even though there is electricity .
This electrical activity can be measured with an ECG (electrocardiogram). However, when you look at your pulse, you won't feel a pulse because the heart isn't beating and pumping blood around the body.
Most importantly, PEA is a "nonshockable" heart rhythm pattern. This means that it cannot be restored by a shock from a defibrillator, as shown in the movies. Therefore, if proper treatment is not received quickly, death can occur within minutes.
There are two types of PEA
Doctors divide this into two main types.
1. Pseudo-PEA: In this, the heart muscle contracts very weakly due to the electrical activity of the heart. Even if it pumps a little blood, it is not as strong as a normal heartbeat. Therefore, there is not enough blood flow to feel a pulse in the body.
2. True PEA: In this, although there is electrical activity in the heart, the heart muscle does not respond at all . That means no blood is pumped at all. No pulse is felt at all.
What is the difference between PEA and Asystole (Flat-lining)?
You've probably seen it in movies, when someone dies, a straight line appears on the monitor with a "beep..." sound. That's what we call `(asystole)` or "flat-lining."
- PEA: There is electricity in the heart, but the heart does not work. (Just like a TV that has electricity , but is broken).
- Asystole: The heart has no electricity, and the heart does not beat. It is completely still. (Like a TV that has been unplugged).
Although both are cases of cardiac arrest, the difference can be identified based on the appearance of the ECG.
What are the main causes of PEA?
There are many factors that can cause PEA. To make it easier to remember these, doctors use a shorthand system called "H's and T's." Let's take a look at what they are.
| Cause Category | Simple Explanation |
|---|---|
| Decreased blood volume (Hypovolemia) | A decrease in the amount of blood in the body due to a cause such as excessive bleeding from a major accident or severe dehydration. |
| Decreased oxygen levels (Hypoxia) | Lack of oxygen to the body due to breathing difficulties and drowning. |
| Changes in the body's acid/salt balance (Hydrogen ion - Acidosis) | Increased acidity in the body due to factors such as kidney failure. Severe changes in electrolyte levels such as potassium. |
| Decreased body temperature (Hypothermia) | Body temperature dropping to a very low level. |
| Ingestion of toxins | Overdose of certain medications, drugs, or other toxic substances. |
| Fluid accumulation around the heart (Tamponade - cardiac) | The cavity around the heart fills with blood or other fluid, causing pressure on the heart. This prevents the heart from beating freely. |
| Tension pneumothorax | A lung bursts, filling the chest cavity with air, compressing the heart and blood vessels. |
| Blood clots (Thrombosis) | A condition such as a heart attack (`myocardial infarction`) or a blood clot in the lungs (`pulmonary embolism`). |
| Physical injuries (Trauma) | Heart damage due to a severe accident to the chest. |
How is this treated?
When someone has PEA, it can be difficult to diagnose outside of the hospital, as it is impossible to tell without an ECG. Fortunately, the first and most important thing to do in any case of cardiac arrest is one thing: CPR (Cardiopulmonary Resuscitation).
1. Start CPR immediately: If someone is unconscious, has no pulse or breathing, call an ambulance immediately and continue chest compressions until they arrive. This is the best chance to save a life. If you don't know how to do CPR, the emergency services can instruct you on how to do it.
2. Treatment at the hospital: After being admitted to the hospital's Emergency Treatment Unit (ETU), doctors will continue to perform CPR and begin other treatments.
- Epinephrine: This is also called adrenaline. This medicine is given to try to restore the heart to a normal rhythm.
- Treating the cause: It is essential to quickly identify the cause of the PEA (one of the causes in the table above) and treat it. For example, if there is blood loss, give blood, if there is insufficient oxygen, give oxygen, if there is blood around the heart, remove it with a syringe.
Remember, PEA is a "nonshockable" rhythm. This means that a shock from a defibrillator will not help. However, with good CPR, sometimes the heart rhythm can change to a shockable rhythm (e.g., `ventricular fibrillation`). At that time, a shock from a defibrillator gives the heart a chance to restart. This is why CPR is so important.
What should we do in an emergency?
Cardiac arrest is always a medical emergency, so immediate action is essential.
Someone in front of you:
- If you suddenly lose consciousness and fall,
- If you can't feel a pulse in your neck or wrist,
- If breathing stops or becomes unusually difficult,
Call an ambulance immediately. Then, start CPR as soon as possible. Every second counts.
Although PEA is a very serious condition, our understanding of it has increased significantly with the advancement of modern medicine. However, the first few minutes are more critical than all of that. Therefore, if you see someone experiencing this, don't panic, start CPR immediately, and get medical help quickly, which can definitely increase the likelihood of saving a life.
Take-Home Message
- PEA is a very serious medical emergency in which the heart has electrical activity but no pulse.
- If someone suddenly falls unconscious, check their pulse and breathing immediately.
- If there is no pulse or breathing, call an ambulance without delay and begin CPR (chest compressions) immediately.
- Although shock treatment (defibrillation) for PEA is usually not successful, continuous CPR may be able to convert the heart to a shockable rhythm.
- The main goal of treatment in the hospital is to find and treat the underlying cause of the PEA while performing CPR.
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