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Pacemaker PEA arrest — DipIMC MCQ

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ModerateResuscitationPacemaker PEA arrestDipIMC

A 66-year-old man with a pacemaker collapses. The monitor shows pacing spikes followed by wide complexes at 60 bpm, but there is no pulse and CPR is underway. What is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Treat as pulseless electrical activity and continue ALS

Electrical activity on the monitor, including paced complexes, does not prove mechanical cardiac output. In the absence of a pulse or signs of life, this is PEA and should be treated with ALS and reversible cause management. Pacemaker interrogation must not interrupt resuscitation. The pearl is that the patient, not the monitor, defines cardiac arrest.

Reference: Resuscitation Council UK Adult ALS Guidelines 2025