03/06/2026
All PEAs are not created equally. The more viable the rhythm and rate, the more viable the patient, and the more likely they’re simply in a profound shock state where the BP is so low that a pulse cannot be readily palpated. Patients rarely die in a narrow complex rhythm.
In the presence of POCUS, these patients can be easily identified by looking for organized cardiac contractility.
In the absence of POCUS, a viable rhythm + ETCO2 should lead to high suspicion of a profound shock state.
In medical patients, this determination may shift care to consistent vasopressor/inotropic support rather than boluses. Compressions may or may not continue to be indicated depending on evidence of (in)adequate cardiac output.
In pulseless trauma patients with an organized rhythm, viability should be recognized while aggressively addressing reversible causes: hypoxia/hypoventilation, hemorrhage, or obstruction (tension or tamponade). Compressions are useless when performed on an empty tank or obstructed heart.
PEAs of narrow complex and/or adequate rate should be considered particularly viable and a potential sign of a low-flow state. Resuscitate and reevaluate.
Does your agency utilize any progressive PEA practices? POCUS? Vasopressor drips instead of boluses?👇🏻
