Just because cardiac arrest survival rates have stagnated over the past 30 years doesn’t mean providers should be pessimistic about every call for pulseless electrical activity (PEA). There are several cases in which cardiac arrest can have positive outcomes, including hypothermic cardiac arrest, cold-water drowning and toxicologic cardiac arrest.
As we consider the specific clinical scenarios in which cardiac arrest can have good outcomes despite prolonged CPR, let’s review some reversible causes of cardiac arrest that can also have positive outcomes. Reviewing the classic “Hs and Ts” of PEA arrest offers a concise way to review some other reversible causes of cardiac arrest in a practical manner that can be remembered and applied in the prehospital setting. (1,2)
The Hs and Ts of Pulseless Electrical Activity Cause Treatment
Hypothermia Warming, both active and passive
Hypoxia” Airway and oxygenation
H+ (acidosis) Improve with overall resuscitation, sodium bicarbonate
Hyperkalemia Albuterol, insulin with dextrose
Hypovolemia Stop any bleeding, fluids, blood products
Thromboemboli Resuscitation, consider thrombolytics
(lung-pulmonary embolism)
Thromboemboli Resuscitation, consider thrombolytics
(heart attack/myocardial infarction)
Tamponade (pericardial) Pericardiocentesis
Tension pneumothorax Needle thoracostomy
Toxins Charcoal
References
- Benson P, Eckstein M: “Pulseless electrical activity: A Case Conference.” Prehospital Emergency Care. 9(2):231235, 2005.
- Koeck WG: “A practical approach to the etiology of pulseless electrical activity. A simple 10-step training mnemonic.” Resuscitation. 30(2):1579, 1995.
Capt. Andrew E. Muck is the assistant director of EMS at Wilford Hall Medical Center at Lackland Air Force Base in Texas. He has served in the United States Air Force for five years and much of this article was written while deployed in Iraq. His recent work has included coordinating a hypothermia protocol for cardiac arrest at his institution. Contact him at Andrew.Muck@lackland.af.mil.
LTC Michael Hilliard is the transitional year program director and staff emergency medicine physician at the San Antonio Uniform Health Education Consortium at Brooke Army Medical Center. He has enjoyed a wide variety of assignments in his career, including time in Baghdad, Iraq, and is currently assigned to the teaching center in San Antonio, Texas.
COL Brice Adams is the chief of emergency medicine and also chief of clinical research at William Beaumont Army Medical Center in Texas. He has enjoyed a wide variety of assignments in his career, ranging from combat assignments to teaching centers. His research and teaching interests focus on resuscitation, trauma and combat casualty care.
