What is the ACLS algorithm for a patient in PEA during arrest?

• A. Treat as nonshockable: start/continue CPR, give epinephrine every 3-5 minutes, search for reversible causes, monitor rhythm; no defibrillation unless a shockable rhythm appears.
• B. Defibrillate immediately.
• C. Do nothing until ROSC occurs.
• D. Administer amiodarone and defibrillate.

Answer: (A)

PEA during arrest is a nonshockable rhythm, so the approach focuses on quality CPR, medication to support circulation, and identifying reversible causes rather than delivering shocks. The best steps are to continue high-quality chest compressions, give epinephrine every 3–5 minutes, and actively search for and treat reversible causes (the Hs and Ts) while monitoring for return of spontaneous circulation. Defibrillation isn’t used in PEA because there’s no shockable rhythm to target; if the rhythm later becomes shockable, defibrillation would then be indicated. This is why treating as nonshockable—CPR, epinephrine, reversible-cause workup, and rhythm monitoring—is the correct approach.