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Had the honour of presenting @UCalgaryEM Grand Rounds today evaluating the evidence for various diagnostic approaches and therapeutic interventions in PEA & pseudo-PEA, looking at adjuncts to our typical ACLS algorithm. Here's the main takeaways: @UofCEMResearch @CalgaryEMres
Pseudo-PEA (+ cardiac activity on bedside U/S) has better survival than true-PEA (no cardiac activity). Finger pulse checks are inaccurate and not SN or SP. Femoral artery US looking for pulsations & compressibility is better. Check out the video from https://doi.org/10.1016/j.resuscitation.2019.03.009
The 3x3 approach (Desbiens, 2008) may be an easier memory tool for the most common causes of PEA arrests than H&Ts during stressful situations. They relate w/ the concept that PEA results from profound shock. Hypoxia worsens all of them. QRS width is not helpful in most cases
Using POCUS can increase time off the chest if not done properly. Have charter count the 10s pause aloud, probe in position before compressions are stopped, record the scan and interpret it AFTER the pause not during. US useful for pericardial effusion, cardiac activity & PTX.
There are small studies indicating pseudo-PEA responds to inotropes/vasopressors with improved survival. Consider them as adjuncts for certain causes.
Finally, based on the lit, here's the algorithm I'm going to implement during my next PEA arrest as team lead. Still emphasizing early CPR and ACLS, but becoming more nuanced as the resus progresses. More data is needed - PEA/pseudo-PEA is ready for research to improve outcomes.
