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 Epinephrine Q3-5 min | ||||||||||||||||||||||||||||||||||||||||||||||||
| Rhythm | |||||||||||||||||||||||||||||||||||||||||||||||||
| Shockable | Non-shockable | ||||||||||||||||||||||||||||||||||||||||||||||||