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Pulseless electrical activity
Classification and external resources
ICD-10 I46.9
DiseasesDB 4166
eMedicine med/2963

Pulseless Electrical Activity or PEA (also known by the older term Electromechanical Dissociation or Non-Perfusing Rhythm) refers to any heart rhythm observed on the electrocardiogram that should be producing a pulse, but is not. The condition may or may not be caused by electromechanical dissociation. The most common cause is hypovolemia.

The normal condition when electrical activation of muscle cells precedes mechanical contraction is known as Electromechanical Coupling.


The approach in treatment of PEA is to treat the underlying cause. These possible causes are remembered as the 6 Hs and the 6 Ts.[1][2][3]


Where an underlying systemic cause cannot be determined rapidly enough, pulseless electrical activity should be treated as if the patient were in asystole. Treatment is intravenous delivery Epinephrine 1 mg every 3-5 minutes, and, if the underlying rhythm is bradycardia, Atropine 1 mg IV up to .04 mg/kg (varies with regional protocols). Both these drugs should be administered along with appropriate CPR techniques. Defibrillators are not used for this rhythm, as the problem lies in the response of the myocardial tissue to electrical impulses.


  1. ^ Mazur, Glen (2003). Acls: Principles And Practice. [Dallas, TX]: Amer Heart Assn. pp. 71–87. ISBN 0-87493-341-2. 
  2. ^ Barnes, Thomas Garden; Cummins, Richard O.; Field, John; Hazinski, Mary Fran (2003). ACLS for experienced providers. [Dallas, TX]: American Heart Association. pp. 3–5. ISBN 0-87493-424-9. 
  3. ^ 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care (December 2005). "Part 7.2: Management of Cardiac Arrest". Circulation 112 (24 Suppl): IV 58–66. doi:10.1161/CIRCULATIONAHA.105.166557. 

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