Pseudo-pulseless electrical activity in foreign body airway obstruction
DOI:
https://doi.org/10.54143/jbmede.v3i3.130Keywords:
POCUS, FBAO, Pseudo-PEA, Case reportAbstract
Foreign body airway obstruction is a common cause of mortality, especially in the pediatric population. Although there is
no universally accepted definition for pseudo- pulseless electrical activity, it is used to describe the evidence of myocardial
contraction on point-of-care ultrasound without palpable pulse. Some authors have proposed that these patients should be
treated as in a profound shock. We report the case of a 7 years old boy who was taken to an Emergency Medical Services
(EMS) station. Cardiopulmonary resuscitation was started and an object removed under direct laryngoscopy. After about
40 minutes of cardiopulmonary resuscitation, the monitor showed an extreme bradycardia with no palpable pulse, but with
contractile activity visible on point-of-care ultrasound. We chose to leave the normal Advanced Life Support flowchart, starting
norepinephrine while maintaining chest compressions and ventilations. After two cycles of cardiopulmonary resuscitation
with pressors the patient had return of spontaneous circulation and was transferred to the local children’s hospital. Point-of-
care ultrasound during cardiopulmonary resuscitation can be a tool to identify the cause of cardiac arrest as well as a guide on
choosing the interventions. The science of resuscitation is still permeated by interventions with a low degree of evidence and
there are no robust studies on pseudo-pulseless electrical activity until this moment. Thus, targeting therapy based on the
search for the cause seems reasonable, and the use of ultrasound has been shown to be a very useful tool.
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