Comment on Grmec et al.: A treatment protocol including vasopressin and hydroxyethyl starch solution is associated with increased rate of return of spontaneous circulation in blunt trauma patients with pulseless electrical activity

Introduction: Pseudo-Pulseless Electrical Activity (p-PEA) is a lifeless form of profound cardiac shock characterized by measurable cardiac mechanical activity without clinically detectable pulses. Patients in pseudo-PEA carry different prognoses than those in true PEA and may require different therapies. Noninvasive technologies capable of detecting return of spontaneous circulation (ROSC) are needed to guide transition therapy from ACLS to critical care. Electrical impedance (EI) measurements across the thorax and abdomen may reflect the state of the cardiovascular system and change with ROSC. Hypothesis: EI measured across the chest wall or abdomen can detect ROSC in p-PEA. Methods: Female swine (N = 14) under intravenous anesthesia were instrumented with aortic and central venous micromanometer catheters. EI was measured with cutaneous belts around the chest and abdomen (Swisstom). p-PEA was induced by ventilation with 6% oxygen in 94% nitrogen and was defined as a systolic aortic pressure < 40 mmHg. Experiments in which ROSC occurred within 20 seconds of starting 100% FiO 2 were studied. EI waveforms were analyzed with fast fourier transforms, and the dominant frequencies of p-PEA and ROSC signals were subtracted to create a difference distribution. Results: With onset of ROSC, there was a characteristic frequency increase in EI measurable across both chest and abdominal bands. Fourier transform analysis demonstrated a significant difference in dominant frequencies between resuscitation and p-PEA. The median difference between resuscitation and p-PEA dominant frequencies were 5.49 in the thorax [95% CI 3.48 - 7.50] and 6.65 in the abdomen [95% CI 3.63 - 9.67]. Conclusions: There appear to be characteristic EI frequency patterns and changes in p-PEA and ROSC. If confirmed clinically, this indicates that EI may be a promising technology for non-invasive monitoring in cardiac arrest.

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ECG characteristics of Pulseless Electrical Activity associated with Return of Spontaneous Circulation in Out-of-Hospital Cardiac Arrest

Resuscitation ◽

10.1016/j.resuscitation.2018.07.098 ◽

2018 ◽

Vol 130 ◽

pp. e54 ◽

Cited By ~ 1

Author(s):

Andoni Elola ◽

Elisabete Aramendi ◽

Unai Irusta ◽

Erik Alonso ◽

Pamela Owens ◽

...

Keyword(s):

Cardiac Arrest ◽

Electrical Activity ◽

Pulseless Electrical Activity ◽

Spontaneous Circulation ◽

Return Of Spontaneous Circulation ◽

Hospital Cardiac Arrest

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8 - ECG characteristics of Pulseless Electrical Activity associated with Return of Spontaneous Circulation in Out-of-Hospital Cardiac Arrest

10.26226/morressier.5b51cf45b1b87b0009beb745 ◽

2018 ◽

Author(s):

Andoni Elola Artano ◽

Elisabete Aramendi

Keyword(s):

Cardiac Arrest ◽

Electrical Activity ◽

Pulseless Electrical Activity ◽

Spontaneous Circulation ◽

Return Of Spontaneous Circulation ◽

Hospital Cardiac Arrest

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ECG changes during resuscitation of patients with initial pulseless electrical activity are associated with return of spontaneous circulation

Resuscitation ◽

10.1016/j.resuscitation.2018.03.039 ◽

2018 ◽

Vol 127 ◽

pp. 31-36 ◽

Cited By ~ 5

Author(s):

Gunnar Waage Skjeflo ◽

Trond Nordseth ◽

Jan Pål Loennechen ◽

Daniel Bergum ◽

Eirik Skogvoll

Keyword(s):

Electrical Activity ◽

Pulseless Electrical Activity ◽

Spontaneous Circulation ◽

Ecg Changes ◽

Return Of Spontaneous Circulation

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Ultrasound for Critical Care Physicians: Sometimes It’s Better to Be Lucky than Smart

Southwest Journal of Pulmonary and Critical Care ◽

10.13175/swjpcc016-21 ◽

2021 ◽

Vol 22 (6) ◽

pp. 116-118

Author(s):

Robert Raschke ◽

◽

Randy Weisman

Keyword(s):

Critical Care ◽

Physical Therapy ◽

Right Ventricle ◽

Electrical Activity ◽

Plasminogen Activator ◽

Point Of Care ◽

Pulseless Electrical Activity ◽

Spontaneous Circulation ◽

Return Of Spontaneous Circulation ◽

Tissue Plasminogen

We recently responded to a code arrest alert in the rehabilitation ward of our hospital. The patient was a 47-year-old man who experienced nausea and diaphoresis during physical therapy. Shortly after the therapists helped him sit down in bed, he became unconsciousness and pulseless. The initial code rhythm was a narrow-complex pulseless electrical activity (PEA). He was intubated, received three rounds of epinephrine during approximately 10 minutes of ACLS/CPR before return of spontaneous circulation (ROSC), and was subsequently transferred to the ICU. Shortly after arriving, a 12-lead EKG was performed (Figure 1), and PEA recurred. Approximately ten-minutes into this second episode of ACLS, a cardiology consultant informed the code team of an S1,Q3,T3 pattern on the EKG. A point-of-care (POC) echocardiogram performed during rhythm checks was technically-limited, but showed a dilated hypokinetic right ventricle (Video 1). Approximately twenty-minutes into the arrest, 50mg tissue plasminogen activator (tPA) was administered, and return …

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Leptospirosis with Pulseless Electrical Activity (PEA) Cardiac Arrest in Multiple Comorbid Patient

Medicine & Health ◽

10.17576/mh.2020.1502.25 ◽

2020 ◽

Vol 15 (2) ◽

pp. 290-296

Author(s):

Ismail Mohd Saiboon ◽

Keyword(s):

Electrical Activity ◽

Pulseless Electrical Activity ◽

Kidney Injury ◽

Spontaneous Circulation ◽

Return Of Spontaneous Circulation ◽

Endemic Diseases ◽

Life Threatening Illness ◽

Life Threatening ◽

History Of ◽

St Elevation

Leptospirosis is one of the endemic diseases in Malaysia. It has a broad spectrum of clinical manifestation ranging from mild illness to life-threatening illness. We report a case of 56-year-old male with multiple comorbidities, who came with history of fever, cough, abdominal pain, vomiting and diarrhea for two days. He presented to the Emergency Department (ED) unresponsive with pulseless electrical activity (PEA). He was resuscitated and achieved return of spontaneous circulation (ROSC) oliguric acute kidney injury and non-ST elevation myocardial infarction (NSTEMI). He was then admitted to intensive care unit (ICU) and treated with IV Ceftriaxone 2 g daily for 4 days then was changed to IV Ceftazidime 2 g twice per day for 1 week because of ventilator acquired pneumonia (VAP). His condition improved and was discharge home well after 18 days of admission.

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