{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:12:09Z","timestamp":1787026329016,"version":"build-2736575974"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,11,5]],"date-time":"2021-11-05T00:00:00Z","timestamp":1636070400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:p>Pulseless electrical activity (PEA) is considered an enigmatic phenomenon in resuscitation research and practice. Finding individuals with no consciousness or pulse but with continued electrocardiographic (EKG) complexes obviously raises the question of how they got there. The development of monitors that can display the underlying rhythm has allowed us to differentiate between VF, asystole, and PEA. 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. 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. 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. The observation from these cases confirms that PEA is a late phase in the clinical dying process. Echocardiographic images delineate the stages of pseudo-PEA with ineffective contractions, PEA, and then asystole. The process is contiuous with none of the sudden phase shifts seen in dysrhythmic events such as VF, VT or SVT. The implications of these findings are that PEA is a common manifestation of tissue hypoxia and metabolic substrate depletion. Our findings offer prospects for studies of the development of interventions to improve PEA survival.<\/jats:p>","DOI":"10.3389\/fcvm.2021.747857","type":"journal-article","created":{"date-parts":[[2023,7,17]],"date-time":"2023-07-17T23:27:06Z","timestamp":1689636426000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Pulseless Electrical Activity: Echocardiographic Explanation of a Perplexing Phenomenon"],"prefix":"10.3389","volume":"8","author":[{"given":"David C.","family":"Parish","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hemant","family":"Goyal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erskine","family":"James","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francis C.","family":"Dane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,11,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"576","DOI":"10.1016\/S0196-0644(96)70160-9","article-title":"The mystery of bradyasystole during cardiac arrest","volume":"27","author":"Ornato","year":"1996","journal-title":"Ann Emerg Med."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1251","DOI":"10.1053\/euhj.2000.2150","article-title":"Experiences from treatment of out-of-hospital cardiac arrest during 17 years in G\u00f6teborg","volume":"21","author":"Herlitz","year":"2000","journal-title":"Eur Heart J."},{"key":"B3","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1007\/s11936-015-0392-z","article-title":"Cardiac arrest: the changing incidence of ventricular fibrillation","volume":"17","author":"Keller","year":"2015","journal-title":"Curr Treat Options Cardiovasc Med."},{"key":"B4","doi-asserted-by":"publisher","first-page":"2532","DOI":"10.1161\/CIRCULATIONAHA.113.004490","article-title":"Pulseless electrical activity: definition, causes, mechanisms, management, and research priorities for the next decade: report from a national heart, lung, and blood institute workshop","volume":"128","author":"Myerburg","year":"2013","journal-title":"Circulation."},{"key":"B5","doi-asserted-by":"publisher","first-page":"807","DOI":"10.1016\/j.amjmed.2014.04.015","article-title":"The epidemic of the 20(th) century: coronary heart disease","volume":"127","author":"Dalen","year":"2014","journal-title":"Am J Med."},{"key":"B6","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1016\/S0300-9572(03)00104-7","article-title":"Success changes the problem: why ventricular fibrillation is declining, why pulseless electrical activity is emerging, and what to do about it","volume":"58","author":"Parish","year":"2003","journal-title":"Resuscitation."},{"key":"B7","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1378\/chest.101.1.123","article-title":"Aortic pressure during human cardiac arrest. 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