Pseudo-pulseless electrical activity: A distinct hemodynamic state in cardiac arrest and its implications for resuscitation

Figure 4 Physiology-guided resuscitation pathway for pseudo-pulseless electrical activity. The algorithm illustrates targeted optimization of coronary and cerebral perfusion using objective hemodynamic and metabolic markers, integrated within guideline-directed advanced cardiac life support, with iterative reassessment of rhythm and perfusion. ACLS: Advanced cardiac life support; AHA: American Heart Association; CPR: Cardiopulmonary resuscitation; ERC: European Resuscitation Council; POCUS: Point-of-care ultrasound; PEA: Pulseless electrical activity; Pseudo-PEA: Pulseless electrical activity with cardiac mechanical activity; EtCO₂: End-tidal carbon dioxide; ROSC: Return of spontaneous circulation; TOR: Termination of resuscitation; LV: Left ventricle; PE: Pulmonary embolism.