Treatment
Cardiopulmonary resuscitation is initiated immediately, although this may not take place if there has been a decision not to resuscitate. The approach in treatment of PEA is to treat the underlying cause, if known (e.g. relieving a tension pneumothorax). Where an underlying cause for PEA cannot be determined and/or reversed, the treatment of pulseless electrical activity is similar to that for asystole.
The mainstay of drug therapy for PEA is epinephrine 1 mg every 3–5 minutes. Although previously the use of atropine was recommended in the treatment of PEA/asystole, this recommendation was withdrawn in 2010 by the American Heart Association due to lack of evidence for therapeutic benefit.
Sodium bicarbonate 1meq per kilogram may be considered in this rhythm as well, although there is little evidence to support this practice. Its routine use is not recommended for patients in this context, except in special situations (e.g. preexisting metabolic acidosis, hyperkalemia, tricyclic antidepressant overdose).
All of 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.
Read more about this topic: Pulseless Electrical Activity
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