Date of Award

Summer 7-15-2022

Document Type


Degree Name

Doctor of Medical Science (DMSc)


Department of Physician Assistant Medicine

First Advisor

Justin M. Gambini, DMSc, PA-C, DFAAPA


Background: Point of care ultrasound (PoCUS) has enabled providers to draw a contrast between true PEA (Pulseless Electrical Activity) and pseudo-PEA. The incorporation of PoCUS pulse checks in PEA and pseudo-PEA has been shown to more accurately predict Return of Spontaneous Circulation (ROSC) when compared to standard manual pulse checks. However, concerns have been raised in recent observational studies regarding increased duration of PoCUS pulse checks compared to manual pulse checks leading to suboptimal CPR and subsequent deterioration of ACLS protocol integrity. Objective: This clinical review aims to examine the utility and practical implementation of PoCUS versus manual pulse check in the prediction of ROSC for patients presenting to the hospital in PEA.

Discussion: A PubMed, MEDLINE, Scopus, and CINAHL databases literature search was conducted with the following search terms: point of care ultrasound (PoCUS), pulseless electrical activity (PEA), Pseudo Pulseless Electrical Activity (Pseudo PEA), manual pulse check, Return of Spontaneous Circulation (ROSC)

Conclusions: PoCUS plays in an important role in predicting ROSC for patients presenting in PEA. Given the importance of the distinction between true PEA and pseudo-PEA, the literature suggests implementation of training for providers in expedient and skillful use of PoCUS to identify pseudo-PEA may be beneficial provided that pauses in CPR are not prolonged.

Ashockleysteven_1078_1513852_Symposium Poster.pdf (1191 kB)
Poster presented at research symposium