Asystole

Asystole

David Ray Velez, MD

Cardiac Arrest with Complete Cessation of Electrical Activity in the Heart

  • The Terminal Rhythm/Endpoint of All Cardiac Arrest

EKG Pattern

  • No Waveform
  • Only an Isoelectric “Flat Line”

Asystole

Reversible Causes of Sudden Cardiac Arrest: “5 H’s and T’s”

  • 5 H’s:
    • Hypovolemia
    • Hypoxia
    • Hydrogen Ions (Acidosis)
    • Hypokalemia/Hyperkalemia
    • Hypothermia/Hyperthermia
  • 5 T’s:
    • Tension Pneumothorax
    • Trauma and Toxins
    • Tamponade (Cardiac)
    • Thrombosis (Pulmonary/PE)
    • Thrombosis (Coronary/MI)
  • “H’s and T’s” are More Often are Associated with PEA Than Asystole

Treatment

  • Follow ACLS Guidelines: *See Cardiac Arrest
  • Start CPR Immediately and Give Oxygen
  • Treat Any Reversible Causes
  • Check Rhythm Every 2 Minutes
    • Asystole is Not a Shockable Rhythm
  • Epinephrine: 1 mg IV/IO, Repeat Every 3-5 Minutes
  • Adjuncts:
    • Calcium Chloride
      • Dose: 1 g IV
      • Vasopressor and Inotropic Effects
      • Not Routinely Given but May Be Considered
    • Sodium Bicarbonate
      • Dose: 50-100 mEq IV (1-2 Amps/Ampules)
      • Can Mitigate the Effects of Acidosis and Hyperkalemia
      • Not Routinely Given but May Be Considered if Concerned for Significant Acidosis or Hyperkalemia

Cardiac Arrest Management Algorithm:

Immediate CPR and Oxygen

Check Rhythm Every 2 Minutes:

  • VF/pVT:
    • Defibrillate
    • Alternate Epinephrine and Amiodarone After Each Check
  • PEA/Asystole:
    • Epinephrine After Every Other Check

Adjuncts:

  • Calcium Chloride
  • Sodium Bicarbonate