Monday December 8, 2008


Q: 56 year old male is intubated in ICU with COPD exacerbation. In last one hour there are frequent "vent. alarms" but silenced by bedside staff. Patient now went into PEA (pulseless electrical activity). RT disconnected patient from ventilator but even before bagging is resumed, patient recovered good pulse and blood pressure?


A: Auto-PEEP induced PEA

Elevated end-expiratory pressure ("auto-PEEP") decreases venous return and may depress cardiac output. Transient withdrawal of ventilation allows the dynamic hyperinflation to be lessened, reducing intrathoracic pressure and permitting the return of spontaneous circulation. On the same token, it is important to avoid aggressive bagging during cardiopulmonary resuscitation.




Reference: click to get article

Auto-PEEP and Electromechanical Dissociation - Volume 335:674-675, Number 9, August 29,1996, NEJM