Kataria S, Goel S, Juneja D. Pseudo-pulseless electrical activity: A distinct hemodynamic state in cardiac arrest and its implications for resuscitation. World J Clin Cases 2026; 14(19): 120233 [DOI: 10.12998/wjcc.120233]
Corresponding Author of This Article
Deven Juneja, MD, Director, Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, 1 Press Enclave Road, New Delhi 110017, India. devenjuneja@gmail.com
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Critical Care Medicine
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review-article
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Kataria S, Goel S, Juneja D. Pseudo-pulseless electrical activity: A distinct hemodynamic state in cardiac arrest and its implications for resuscitation. World J Clin Cases 2026; 14(19): 120233 [DOI: 10.12998/wjcc.120233]
World J Clin Cases. Jul 6, 2026; 14(19): 120233 Published online Jul 6, 2026. doi: 10.12998/wjcc.120233
Pseudo-pulseless electrical activity: A distinct hemodynamic state in cardiac arrest and its implications for resuscitation
Sahil Kataria, Sargam Goel, Deven Juneja
Sahil Kataria, Department of Critical Care Medicine, Holy Family Hospital, New Delhi 110025, India
Sargam Goel, Department of Anesthesiology, ESI Hospital, Okhla, New Delhi 110020, India
Deven Juneja, Institute of Critical Care Medicine, Max Super Speciality Hospital, New Delhi 110017, India
Author contributions: Kataria S and Goel S contributed to the conceptualization, study design, literature synthesis, drafting of the manuscript, critical revisions, and final approval; Juneja D contributed to the intellectual input, critical manuscript revision, and overall supervision of the work; All authors approved the final manuscript.
AI contribution statement: The authors used ChatGPT and Grammarly only for limited language polishing, grammar correction, and improvement of readability during manuscript preparation.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Corresponding author: Deven Juneja, MD, Director, Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, 1 Press Enclave Road, New Delhi 110017, India. devenjuneja@gmail.com
Received: February 24, 2026 Revised: April 10, 2026 Accepted: June 1, 2026 Published online: July 6, 2026 Processing time: 132 Days and 13.6 Hours
Core Tip
Core Tip: Pulseless electrical activity (PEA) is traditionally treated as a uniform non-shockable cardiac arrest rhythm. Yet, bedside ultrasound and perfusion monitoring increasingly reveal a subgroup with residual cardiac mechanical activity called PEA with cardiac mechanical activity. This review reframes PEA with cardiac mechanical activity as a low-flow arrest state rather than true electromechanical dissociation, summarizes prognostic and physiological evidence supporting this distinction, and highlights the limitations of rhythm-based resuscitation algorithms. We propose a structured, physiology-guided resuscitation strategy that integrates time-limited ultrasound with perfusion targets to guide treatment escalation while preserving the quality of cardiopulmonary resuscitation.
