PEA has a poor prognosis and no unifying accepted definition. This is problematic because the percentage of dying patients who are discovered in PEA in in-hospital and pre-hospital studies is now consistently higher than that of Ventricular Fibrillation (VF) ( 2, 3). Pulseless electrical activity (PEA) is a phase in the dying process of humans and animals which is poorly understood by researchers and physicians involved in resuscitation research and practice ( 1). Our findings offer prospects for studies of the development of interventions to improve PEA survival. The implications of these findings are that PEA is a common manifestation of tissue hypoxia and metabolic substrate depletion. The process is contiuous with none of the sudden phase shifts seen in dysrhythmic events such as VF, VT or SVT. Echocardiographic images delineate the stages of pseudo-PEA with ineffective contractions, PEA, and then asystole. The observation from these cases confirms that PEA is a late phase in the clinical dying process. This paper presents a small case series of individuals with brain death whose family members consented to the echocardiographic observation of the dying process after disconnection from life support. Over 30 years of studying and practicing resuscitation have allowed the authors to see a substantial rise in PEA with variable survival rates, based on the patients' illness spectrum and intensity of monitoring. Lack of clear understanding of the emergence of PEA has limited the research and development of interventions that might improve the low rates of survival typically associated with PEA. The development of monitors that can display the underlying rhythm has allowed us to differentiate between VF, asystole, and PEA. Finding individuals with no consciousness or pulse but with continued electrocardiographic (EKG) complexes obviously raises the question of how they got there. Pulseless electrical activity (PEA) is considered an enigmatic phenomenon in resuscitation research and practice. 5Department of Psychology, Radford University, Radford, VA, United States.4Department of Internal Medicine, Atrium Health Navicent, Macon, GA, United States.3Mercer University School of Medicine, Macon, GA, United States.2The Wright Center for Graduate Medical Education, Scranton, PA, United States.1Department of Medicine, Mercer University School of Medicine, Macon, GA, United States.Parish 1 Hemant Goyal 2,3 * Erskine James 4 Francis C.
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