Pseudo-Pulseless Electrical Activity With Anaphylaxis in a Pediatric Surgical Patient: A Case Report

Pseudo-pulseless electrical activity (p-PEA) is a clinical condition where cardiac output drops severely enough to produce a non-palpable pulse in the setting of organized electrical activity of the heart, but imaging or monitors display evidence of cardiac motion. It may be seen in shock states such as anaphylactic shock. We describe a case where a previously healthy teenage patient presenting for operative removal of orthopedic hardware developed p-PEA after anaphylaxis to antibiotics. Despite loss of pulses and severe mottling of the skin, the patient's pulse oximetry (plethysmography) and capnometry (measurement of end-tidal carbon dioxide) displayed visually normal, reassuring waveforms. The condition responded to chest compressions and administration of epinephrine and vasopressin; the patient was ultimately able to be discharged home on postoperative day (POD) 2. Prompt recognition, diagnosis, and clinical management of p-PEA and anaphylaxis are key to good patient outcomes. Epinephrine is the mainstay of treatment for anaphylactic reactions and is indicated during cardiopulmonary resuscitation (CPR) for p-PEA.