What is Pulseless Electrical Activity (PEA)? | ACLS Certification Association

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Pulseless Electrical Activity (PEA) is one of the non-shockable rhythms in the Adult Cardiac Arrest Algorithm—and it’s a major test topic because it’s easy to confuse with other arrest rhythms.

In this lesson, we break down what PEA actually means: an organized electrical rhythm on the monitor that should have a pulse… but doesn’t. In other words, the ECG may “look alive,” but the patient is pulseless.

You’ll learn:
✅ Where PEA fits in the cardiac arrest algorithm (non-shockable branch)
✅ What PEA stands for and why VF, pulseless VT, and asystole are NOT PEA
✅ Why some PEA patients may still have weak mechanical contraction—just not enough to generate a palpable pulse
✅ How clinicians can assess for mechanical activity using heart tones and point-of-care ultrasound (often described as ultrasound/Doppler assessment)
✅ The two most common adult causes of PEA: hypovolemia and hypoxia
✅ How the ECG can give clues (wide/slow vs narrow/tachy) and what that suggests:

Wide + slow: consider severe/terminal physiology; evaluate reversible causes like hyperkalemia or hypothermia

Narrow + tachy: think hypovolemia/occult blood loss → prioritize rapid volume resuscitation as appropriate

Key takeaway: PEA management is cause-driven. Identify the underlying problem fast and treat it immediately.

???? Comment below: In a PEA arrest, what’s the first reversible cause you actively rule out—hypovolemia, hypoxia, hyperkalemia, hypothermia, or something else?

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Cardiology
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