UMEM Educational Pearls

Title: Can the characteristics of PEA hint at mortality?

Category: EMS

Keywords: cardiac arrest, EMS, TOR (PubMed Search)

Posted: 4/16/2025 by Jenny Guyther, MD (Updated: 5/25/2025)
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Pulseless electrical activity (PEA) is the initial rhythm in up to 25% of out of hospital cardiac arrests.  

This paper is a systemic review and analysis examining if the rate or width of the initial PEA qrs complex was associated with survival.  The qrs complex was either wide (>= 120 ms) or narrow (<120ms) and a frequency of fast (>= 60/s) or slow (<60/s).  7 studies including 9727 patients were included.  Analysis showed:

- mortality was higher in the wide qrs group compared to narrow

- mortality was higher in the slow PEA rate compared to fast

- neurological outcome was better in patients with a fast PEA rate compared to slow.

References

Kim JH, Lee J, Shin H, et al. Association Between QRS Characteristics in Pulseless Electrical Activity and Survival Outcome in Cardiac Arrest Patients: A Systematic Review and Meta-Analysis. Prehosp Emerg Care. Published online June 3, 2024. doi:10.1080/10903127.2024.2360139