What is PEA (Pulseless Electrical Activity) Cardiac Arrest?
PEA is when your heart's electrical system is still working and sending signals, but your heart muscle isn't pumping blood effectively enough to create a pulse—essentially, the heart looks like it's trying to beat on a monitor, but no blood is actually circulating through your body. 1
Understanding PEA in Simple Terms
Think of your heart like a car:
- Normal heart function: The engine (electrical system) runs AND the wheels (heart muscle) turn to move the car forward (pump blood)
- PEA cardiac arrest: The engine is running and making noise (electrical activity on the monitor), but the wheels aren't turning (no pulse, no blood flow) 2
This is different from other types of cardiac arrest where the heart's electrical system completely stops or goes haywire with chaotic rhythms. 1
Why PEA Happens
The good news is that PEA is often caused by fixable problems, which doctors remember using "H's and T's": 1, 3
The H's (problems starting with H):
- Hypovolemia: Not enough blood in your body (from bleeding or severe dehydration) 3
- Hypoxia: Not enough oxygen getting to your heart 3, 4
- Hydrogen ion (acidosis): Your blood becomes too acidic 3
- Hypo/Hyperkalemia: Potassium levels in your blood are too low or too high 3
- Hypothermia: Body temperature drops too low 3
The T's (problems starting with T):
- Tension pneumothorax: Collapsed lung putting pressure on your heart 3
- Tamponade: Fluid around the heart squeezing it 3, 5
- Toxins: Poisoning or drug overdose 3
- Thrombosis: Blood clots in the heart or lungs 2, 6
- Trauma: Severe injury 4
What Happens During Treatment
When someone has PEA cardiac arrest, medical teams immediately: 2
- Start chest compressions (pushing hard and fast on the chest to manually pump blood) 2
- Give oxygen to help the brain and organs 3
- Give medications like epinephrine (adrenaline) every 3-5 minutes to help the heart 1, 3
- Search for and fix the underlying cause—this is the most important part because PEA won't resolve unless the root problem is addressed 1, 3
The Reality About Survival
PEA has a poor but not zero chance of survival, which is why immediate action and finding the reversible cause is so critical. 1 The key difference between someone surviving or not often comes down to how quickly the medical team identifies and treats the underlying problem causing the PEA. 1, 3
For example, if PEA is caused by a blood clot in the lungs (pulmonary embolism), doctors may give clot-busting medications even during CPR, and patients can survive with good brain function if treated quickly enough. 6 If it's caused by fluid around the heart (tamponade), draining that fluid can bring someone back. 5
Bottom Line
PEA means your heart's electrical wiring is working, but the pump has failed—and the race is on to find out why and fix it before permanent damage occurs. 1 Unlike some cardiac arrests where the problem is purely electrical, PEA almost always has an underlying mechanical or chemical cause that needs to be identified and corrected. 1, 3