UMEM Educational Pearls

Title: PEA Arrest...Look for AAA rupture and Tamponade

Category: Vascular

Posted: 4/15/2008 by Rob Rogers, MD (Updated: 3/5/2026)
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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:

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.

Meron, et al. Resuscitation 2004