Asystole resident survival guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahmoud Sakr, M.D. [2]

Definition

Asystole is a state of no cardiac electrical activity, hence no contractions of the myocardium and no cardiac output or blood flow. Asystole is also known as a cardiac arrest rhythm in which there is no distinct electrical activity on ECG. A (flat line) is another acronym for asystole. In asystole, the heart will not respond to defibrillation because it is already depolarized.

Causes

Life Threatening Causes

Asystole is a life-threatening condition and must be treated as such irrespective of the causes. Life-threatening conditions can result in death or permanent disability within 24 hours if left untreated.

Common Causes

• Hydrogen ions (Acidosis)
• Hyperkalemia or Hypokalemia
• Hypoglycemia
• Hypothermia
• Hypovolemia
• Hypoxia
• Cardiac Tamponade
• Tablets or Toxins (Drug overdose)
• Tension pneumothorax
• Thrombosis (Myocardial infarction)
• Thrombosis (Pulmonary embolism)
• Trauma (Hypovolemia from blood loss)

Management

Below is an algorithm summarizing the approach to a patient with asystole. Based on the 2010 American heart association ACLS algorithm for asystole

Asystole

Start CPR for 2 minutes Give oxygen Attach monitor and defibrillator IV/IO access Epinephrine Q3-5 min Consider advanced airway, capnography

Rhythm

Shockable

Non-shockable

See VF/VT algorithm

CPR for 2 minutes Treat Hs&Ts

Rhythm

Shockable

Non-shockable

References

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