Editing Pulseless electrical activity (section)

==Treatment==
Cardiac resuscitation guidelines (ACLS/BCLS) advise that [[cardiopulmonary resuscitation]] should be initiated promptly to maintain [[cardiac output]] until the PEA can be corrected. The approach in treatment of PEA is to treat the underlying cause, if known (e.g. relieving a tension pneumothorax). Where an underlying cause for PEA cannot be determined and/or reversed, the treatment of pulseless electrical activity is similar to that for [[asystole]].<ref name="2010AHA" /> There is no evidence that external cardiac compression can increase cardiac output in any of the many scenarios of PEA, such as hemorrhage, in which impairment of cardiac filling is the underlying mechanism producing loss of a detectable pulse.{{citation needed|date=October 2014}}

A priority in resuscitation is placement of an intravenous or [[Intraosseous infusion|intraosseous line]] for administration of medications. The mainstay of drug therapy for PEA is [[epinephrine]] (adrenaline) 1&nbsp;mg every 3–5 minutes. Although previously the use of [[atropine]] was recommended in the treatment of PEA/asystole, this recommendation was withdrawn in 2010 by the [[American Heart Association]] due to lack of evidence for therapeutic benefit.<ref name="2010AHA">{{cite journal |author=2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care |title=Part 8: Adult Advanced Cardiovascular Life Support|journal=Circulation  |date=November 2010 |volume=122 |issue=18 Suppl |pages=S729–S767 | doi=10.1161/CIRCULATIONAHA.110.970988|pmid=20956224|doi-access=free }}</ref> Epinephrine too has a limited evidence base, and it is recommended on the basis of its mechanism of action.{{citation needed|date=February 2021}}

Sodium bicarbonate 1meq per kilogram may be considered in this rhythm as well, although there is little evidence to support this practice. Its routine use is not recommended for patients in this context, except in special situations (e.g. preexisting metabolic acidosis, hyperkalemia, [[tricyclic antidepressant overdose]]).<ref name="2010AHA" />

All of these drugs should be administered along with appropriate CPR techniques. [[Defibrillator]]s cannot be used to correct this rhythm, as the problem lies in the response of the myocardial tissue to electrical impulses.{{citation needed|date=February 2021}}