To the Editor,
We read with great interest the letter to the editor written by Chung and Yip on the potential influence of pseudo-pulseless electrical activity (PEA) on the results of one of our recently published articles.
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In their letter, Chung and Yip propose that the initial increase in the proportions of shockable rhythm, at the expense of patients in PEA, could be explained by patients in PEA with cardiac activity transitioning to ventricular fibrillation (VF). They conclude that point-of-care ultrasound could help us differentiate PEA without cardiac activity from PEA with cardiac activity and help adjust their treatment.We agree that some of the patients categorized as being in PEA in our study might have had cardiac activity and underwent early spontaneous conversion to VF. However, the proportions of patients with PEA and no cardiac activity as compared to those with cardiac activity who experience a conversion to VF remains uncertain, as it is highly difficult to differentiate these two entities in a prehospital environment.
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The prevalence itself of cardiac activity among out-of-hospital cardiac arrest (OHCA) patients with PEA is also unknown, as their ultrasonographic assessment are usually only performed after a significant period of resuscitation.5.
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It is probable that OHCA patients with cardiac activity have a better prognosis than those who do not.
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The prognostic impact of a transition to VF for PEA patients with cardiac activity is also debated.3.
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Building upon our work, further description of the prevalence and evolution of cardiac activity among OHCA patients with PEA should be performed. This could help us identify sociodemographic, clinical, or electrocardiographic characteristics which could easily identify patients with remaining cardiac activity.Declaration of Competing Interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Acknowledgments
The authors received funding for the overarching project from the ‘Département de médecine familiale et de médecine d’urgence de l’Université de Montréal’ and the ‘Fonds des Urgentistes de l’Hôpital du Sacré-Cœur de Montréal’. The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. We have no competing interests to declare.
References
- Electrical rhythm degeneration in adults with out-of-hospital cardiac arrest according to the no-flow and bystander low-flow time.Resuscitation. 2021;
- Pseudo-PEA: an easily overlooked player in cardiac arrest.Resuscitation. 2021;
- Prognostic impact of the conversion to a shockable rhythm from a non-shockable rhythm for patients suffering from out-of-hospital cardiac arrest.Resuscitation. 2019; 140: 43-49
- Prognostic significance of spontaneous shockable rhythm conversion in adult out-of-hospital cardiac arrest patients with initial non-shockable heart rhythms: A systematic review and meta-analysis.Resuscitation. 2017; 121: 1-8
- Emergency department point-of-care ultrasound in out-of-hospital and in-ED cardiac arrest.Resuscitation. 2016; 109: 33-39
- Quantitative characterization of left ventricular function during pulseless electrical activity using echocardiography during out-of-hospital cardiac arrest.Resuscitation. 2021;
Article info
Publication history
Published online: September 09, 2021
Accepted:
September 1,
2021
Received:
August 28,
2021
Identification
Copyright
© 2021 Published by Elsevier B.V.
ScienceDirect
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- Pseudo-PEA: An easily overlooked player in cardiac arrestResuscitationVol. 168
- PreviewWe read with great interest the important study by Cournoyer et al.1 on the relationship between electrical rhythm degeneration in adult out-of-hospital cardiac arrest (OHCA) and no-flow (NFT) or bystander low-flow time (BLFT). With their results, the authors concluded with the importance of timely cardiopulmonary resuscitation (CPR); but there are other aspects in their results that are worth further discussion.
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