Background In the United Kingdom, out of hospital cardiac arrest patients with pulseless electrical activity (PEA) have a poor survival to discharge rate of 5.3%.1 PEA is managed according to national guidelines.2 These guidelines are imperfect due to limited research resulting in ambulance services locally amending guidelines to support resuscitation decisions.3 This review aimed to examine the local guidelines of UK ambulance services for the management of PEA.
Methods A three-step search strategy was applied from August 2020 to October 2020. 1) A search of UK ambulance service websites was conducted to identify published local guidelines. Where guidelines were not available a written request was made for the guideline, associated guideline or a narrative summary in the absence of a guideline. 2) Documents referenced within the local guidelines specific to pulseless electrical activity were identified and extracted as supporting literature. 3) Documents referenced in the supporting literature identified as having pulseless electrical activity in the title were extracted.
Results Twenty-two documents of textual data met the inclusion criteria. Twenty-nine conclusions were extracted and analysed to generate ten categories, forming three synthesised themes relating to the variability in the clinical management of PEA between UK ambulance services, the early identification of reversible causes and appropriate treatment options to increase survivability and the consensus for further research.
Conclusion Comprehensive national guidelines are lacking due to limited research. The local clinical guidelines and practices of UK ambulance services which aim to address the gaps in research, introduce variability in the management of pulseless electrical activity. Early identification and treatment to reverse the cause of pulseless electrical activity was highlighted to improve patient survival, however, this was complex and challenging to achieve during pre-hospital resuscitation. There was a consensus in the paucity of evidence and the potential for future prognostic research to improve patient outcomes.
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