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What is Asystole

Asystole is sometimes referred to as a “flat line” on the monitor.  It represents the absence of both electrical and mechanical activity of the heart.

If the patient does not have a pulse and asystole is confirmed in one lead, the ACLS team should check another lead and the monitor’s amplitude to make sure the apparent asystole is not actually fine ventricular fibrillation. It is also important to determine the H’s and T’s to discover why the patient went into cardiac arrest and to treat any reversible causes of asystole.

Asystole ECG

Asystole Treatment

Asystole is not a shockable rhythm and treatment for asystole involves high quality CPR, airway management, IV or IO therapy, and medication therapy, which is 1 mg epinephrine 1:10,000 every 3-5 minutes rapid IV or IO push.

It is rare for asystole to be reversed, especially after a long duration. If the patient does not respond to the BLS and ACLS treatments, the rescue team will need to decide when to stop resuscitative efforts. If there is a high degree of certainty that the patient will not respond to further ACLS interventions, it would be appropriate to stop. The decision must be based on specific protocols and the consideration of time from collapse to CPR, time from collapse to first defibrillation attempt, underlying causes, response to resuscitative measures, and an ETCO2 less than 10 after 20 minutes of CPR.