PEA & Asystole Algorithm
AHA 2015 ACLS Algorithm for the treatment of Pulseless Electrical Activity (PEA) and Asystole
PEA and Aystole are two “non-shockable” rhythms that can be found in patients in cardiac arrest. Asystole is the absence of electrical activity and PEA is the presence of an organized rhythm but with no pulse or signs of perfusion.
Treatment of PEA and Asystole are based around providing effective CPR and identifying and treating reversible causes also know as the H’s and T’s.
Perform initial assessment
Perform High Quality CPR with supplemental O2 and attach ECG
Immediately resume High Quality CPR for 2 minutes and initiate IV/IO
Administer Epinephrine 1mg IV/IO q/3-5 minutes once IV/IO initiated.
Consider advanced airway (ETT, Supraglottic Airway)
Consider Reversible Causes (H’s & T’s)
Continue 2 min cycles and provide subsequent CPR and Rx until:
The monitor and assessment show V-Tach or V-Fib, move to V-Tach/V-Fib algorithm
If the patient attains Return of Spontaneous Circulation (ROSC), provide Post Cardiac Arrest Care
If patient is in asystole and remains so for 2 rounds of epi and a fluid bolus, begin considering terminating resuscitative efforts.
- Providing high quality CPR with minimal interruptions and identifying/treating reversible causes are key to patient survival.
Consider and treat potential reversible causes throughout an arrest or dysrhythmias
Hypovolemia: S/S - Rapid heart rate and narrow QRS on ECG; other symptoms of low volume TX - Infusion of normal saline or Ringer’s lactate
Hypoxia: S/S -Slow heart rate TX - Airway management and effective oxygenation
Hydrogen Ion Excess (Acidosis): S/S - Low amplitude QRS on the ECGHyperventilation TX - consider sodium bicarbonate bolus
Hypoglycemia: S/S - Bedside glucose testing TX - IV bolus of dextrose
Hypokalemia: S/S - Flat T waves and appearance of a U wave on the ECG TX - IV Magnesium infusion
Hyperkalemia: S/S - Peaked T waves and wide QRS complex TX - Consider calcium chloride, sodium bicarbonate, or an insulin and glucose protocol
Hypothermia: S/S - Typically preceded by exposure to a cold environment; TX - Gradual rewarming
Tension Pneumothorax: S/S -Slow heart rate and narrow QRS complexes on the ECG; difficulty breathing TX -Thoracostomy or needle decompression
Tamponade – Cardiac: S/S - Rapid heart rate and narrow QRS complexes on the ECG TX - Pericardiocentesis
Toxins: S/S - Typically will be seen as a prolonged QT interval on the ECG; may see neurological symptoms TX - Based on the specific toxin
Thrombosis (PE): S/S - Rapid heart rate with narrow QRS complexes on the ECG TX - Surgical embolectomy or administration of fibrinolytics
Thrombosis (MI): S/S - ECG will be abnormal based on the location of the infarction TX - Dependent on extent and age of MI