Pulseless Electrical Activity: Detection of Underlying Causes in a Prehospital Setting

The proportion of out-of-hospital cardiac arrests (OHCA) with pulseless electrical activity (PEA) as initial rhythm is increasing. PEA should be managed by identifying the underlying cause of the arrest and treating it accordingly. This often poses a challenge in the chaotic prehospital environment with only limited resources available. The aim of this study was to review the diagnostic tools, available in a prehospital setting, and their interpretation during cardiac arrest with PEA as initial rhythm. A systematic literature search of the Pubmed database was performed. Articles were assessed for eligibility by title, abstract and full text. Ultrasonography has become a great asset in detecting underlying causes and a variety of protocols have been proposed. There are currently no studies comparing these protocols regarding their feasibility and their effect on patient survival. Further research concerning the relationship between ECG characteristics and underlying causes is required. Limited evidence suggests a role for point-of-care testing in detecting hyperkalemia and a role for capnography in the diagnosis of asphyxia cardiac arrest. Multiple studies describe a prognostic potential. Although evidence about the prognostic potential of cerebral oximetry in OHCA is accumulating, its diagnostic potential is still unknown. In the management of OHCA, anamnestic and clinical information remains the initial source of information in search for an underlying cause. Ultrasonographi...
Source: Medical Principles and Practice - Category: Internal Medicine Source Type: research