Pulseless electrical activity (PEA) can cause cardiac arrest and occurs when any medical disorder causes severe hypotension during which the blood pressure drops critically low to the point where peripheral pulses are not palpable. There must be some form of electrical activity on the ECG or telemetry that is not ventricular tachycardia, ventricular fibrillation or asystole. Pulseless electrical activity frequently manifests as a very slow QRS complex with heart rates less than 40 beats per minute.
The causes are best remembered by the 6 H’s and the 6 T’s:
Treatment includes emergency initiation of Advanced Cardiac Life Support (ACLS) protocols which includes treatment aimed at the etiology if able to be identified.