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PEA Arrest...Look for AAA rupture and Cardiac Tamponade
If a patient presents in cardiac arrest (particularly PEA), consider the following diagnoses in addition to the causes commonly taught in ACLS:
- AAA with rupture
- Aortic Dissection complicated by tamponade
A 2004 study in Resuscitation by Meron et al. showed the following:
- Approximately 50% of the patients who presented in PEA arrest from a AAA rupture did NOT have abdominal or flank pain prior to arrest
- Approximately 50% of the patients who presented in PEA arrest from cardiac tamponade (from aortic dissection) did NOT have chest pain prior to arrest
- Bedside US was diagnostic in all cases in this subset of patients with PEA arrest of unknown cause
Take home point for the emergency physician:
- Pull the US machine out very early on in the resuscitation of the PEA arrest patient....get the probe on as soon as you can.
References
Meron, et al. Resuscitation 2004