Pseudo-pulseless electrical activity in foreign body airway obstruction

Foreign body airway obstruction is a common cause of mortality, especially in the pediatric population. Although there isno universally accepted definition for pseudo- pulseless electrical activity, it is used to describe the evidence of myocardialcontraction on point-of-care ultrasound without palpable pulse. Some authors have proposed that these patients should betreated as in a profound shock. We report the case of a 7 years old boy who was taken to an Emergency Medical Services(EMS) station. Cardiopulmonary resuscitation was started and an object removed under direct laryngoscopy. After about40 minutes of cardiopulmonary resuscitation, the monitor showed an extreme bradycardia with no palpable pulse, but withcontractile activity visible on point-of-care ultrasound. We chose to leave the normal Advanced Life Support flowchart, startingnorepinephrine while maintaining chest compressions and ventilations. After two cycles of cardiopulmonary resuscitationwith pressors the patient had return of spontaneous circulation and was transferred to the local children’s hospital. Point-of-care ultrasound during cardiopulmonary resuscitation can be a tool to identify the cause of cardiac arrest as well as a guide onchoosing the interventions. The science of resuscitation is still permeated by interventions with a low degree of evidence andthere are no robust studies on pseudo-pulseless electrical activity until this moment. Thus, targeting therapy based on thesearch for the cause seems reasonable, and the use of ultrasound has been shown to be a very useful tool.