Asystole is defined as a cardiac arrest rhythm in which there is no discernible electrical activity on the ECG monitor. Consequently, it is sometimes referred to as a “flat line.”
In the hospital, it is usually the nurse who first identifies a patient in asystole and sounds the alarm. Asystole should be treated according to current American Heart Association BLS and ACLS guidelines.
(Asystole is also the final rhythm of a patient initially in VFib or pulseless V-tach.) Prolonged efforts are unnecessary and futile unless special resuscitation situations exist, such as hypothermia and drug overdose.
B. Before attempting defibrillation, it may be necessary to obtain a 12-lead ECG on the patient. C. Not all cardiac arrests are due to problems that respond to defibrillation. D. All of the above
Asystole is treated by cardiopulmonary resuscitation (CPR) combined with an intravenous vasopressor such as epinephrine (a.k.a. adrenaline). Sometimes an underlying reversible cause can be detected and treated (the so-called "Hs and Ts", an example of which is hypokalaemia).
Asystole represents the absence of both electrical and mechanical activity of the heart. 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 1mg epinephrine 1:10,000 every 3-5 minutes rapid IV or IO push.
Treatment / Management Asystole is a non-shockable rhythm. Therefore, if asystole is noted on the cardiac monitor, no attempt at defibrillation should be made. High-quality CPR should be continued with minimal (less than five seconds) interruption. CPR should not be stopped to allow for endotracheal intubation.
Asystole (ay-sis-stuh-lee) is when there's no electricity or movement in your heart. That means you don't have a heartbeat. It's also known as flatline. That's because doctors check the rhythm of your heart with a machine called an electrocardiogram -- also called an ECG or EKG.
Epinephrine is considered the single most useful drug in cardiac arrest; however, some authorities question its clinical effectiveness in humans This agent is used to increase coronary and cerebral blood flow during cardiopulmonary resuscitation (CPR) and may enhance automaticity during asystole.
High-quality CPR is the mainstay of treatment and the most important predictor of favorable outcomes. Asystole is a non-shockable rhythm. Therefore, if asystole is noted on the cardiac monitor, no attempt at defibrillation should be made.
All healthcare workers, including the nurse practitioner, should be familiar with asystole and its management. In the hospital, it is usually the nurse who first identifies a patient in asystole and sounds the alarm.
The causes of asystole in cardiac arrest are wide and varied. Asystole typically results from decompensation of prolonged ventricular fibrillation arrest. Additionally, attempted defibrillation of ventricular tachycardia or ventricular fibrillation can precipitate asystole. However, any cause of cardiac arrest can eventually result in asystole if not promptly treated. When evaluating a patient with an initial cardiac rhythm of asystole, the reversible causes must be considered. A useful mnemonic taught in Advanced Cardiac Life Support (ACLS) for the reversible causes of cardiac arrest involves the Hs and Ts. The Hs include Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo/Hyperkalemia, and Hypothermia. The Ts include Tension pneumothorax, Tamponade (cardiac), Toxins, and Thrombosis (both pulmonary and coronary). When identified, these cases should be immediately treated. [5][6]
Asystole results from failure of the heart’s intrinsic electrical system or an extracardiac cause. Extracardiac causes are varied. They include the Hs and Ts discussed above and their causes. Asystole typically occurs as a deterioration of the non-perfusing ventricular rhythms. If not rapidly corrected, electrical and mechanical cessation of cardiac activity will occur. This is manifested as asystole on the cardiac monitor.
Asystole, colloquially referred to as flatline, represents the cessation of electrical and mechanical activity of the heart. Asystole typically occurs as a deterioration of the initial non-perfusing ventricular rhythms: ventricular fibrillation (V-fib) or pulseless ventricular tachycardia (V-tach). Additionally, pulseless electrical activity (PEA) can cease and become asystole. Victims of sudden cardiac arrest who present with asystole as the initial rhythm have an extremely poor prognosis (10% survive to admission, 0 to 2% survival-to-hospital discharge rate).[1][2][3] Asystole represents the terminal rhythm of a cardiac arrest.
Extrapolation of one large data set estimates approximately 200,000 in-hospital adult cardiac arrest cases per year. This estimate was confirmed in a second study using the Get With The Guidelines-Resuscitation registry. Neither of these studies investigated cardiac rhythms associated with cardiac arrest. [1][9]
Asystole is considered a terminal rhythm of cardiac arrest. Therefore, discussion of termination of resuscitation should be considered during an in-hospital cardiac arrest in the appropriate clinical picture. Out-of-hospital cardiac arrest patients in asystole should also be considered for the cessation of efforts according to local protocol. [4]
High-quality CPR is the mainstay of treatment and the most important predictor of a favorable outcome. Asystole is a non-shockable rhythm. Therefore, if asystole is noted on the cardiac monitor, no attempt at defibrillation should be made. High-quality CPR should be continued with minimal (less than five seconds) interruption. CPR should not be stopped to allow for endotracheal intubation. Epinephrine (1 mg via intravenous or intraosseous line) should be delivered every three to five minutes, and treatment of reversible causes addressed.
Asystole represents the absence of both electrical and mechanical activity of the heart. 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 1mg epinephrine 1:10,000 every 3-5 minutes rapid IV or IO push. It’s 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 often represents the patient’s final rhythm. Their cardiac function has diminished to a point when all electrical and functional cardiac activity finally stops and the patient dies. (Asystole is also the final rhythm of a patient initially in VFib or pulseless V-tach.) Prolonged efforts are unnecessary and futile unless special resuscitation situations exist, such as hypothermia and drug overdose.
Asystole, also known as "flat line", is a term that means no ventricular activity. It is a lethal arrhythmia which no electrical or mechanical activity in the heart. There is no pulse and no circulation of blood. Asystole is most commonly seen after extended untreated sudden cardiac arrest.
Unless there are special circumstances like hypothermia or drug overdose, prolonged resuscitative efforts beyond 20 minutes are usually unnecessary and futile. The team leader may consider stopping resuscitation if ETCo2 is less than 10 after 20 minutes of high quality CPR and all treatments have been exhausted.
Asystole, sometimes referred to as a flat line on the monitor, represents an absence of both electrical and mechanical activity in the heart. It’s important to understand that if a patient has no pulse and this is confirmed in one lead, there are a few things ACLS providers can double-check to confirm this, such as asking the following questions:
Continue high-quality CPR for two minutes, while also attempting to establish IV or IO access.
Asystole is not a shockable rhythm. So, treatment will involve high-quality CPR, airway management, IV or IO therapy, and medication therapy – specifically 1mg of epinephrine 1:10,000 concentration every 3 to 5 minutes via rapid IV or IO push.
An echocardiogram is indicated to evaluate the functioning of the mitral valve (and other heart valves) and blood flow through it. If there is a leak through the mitral valve, the echocardiogram will detect the blood flow. Because the mitral valve is on the left side of the heart, a right-heart catheterization could not detect any problem with it. A PA chest radiograph will indicate the size of the heart but is not able to detect any valve problems. A stress test will evaluate the patient's ability to exercise. But, any limitation cannot be specified to the mitral or any other heart valve.
A loose electrode or shivering would cause different types of artifacts. Miscalibration would not cause inversion of the QRS complex .
A. Check the other arm for a blood pressure.
All are correct except that the air/O2 intake valve should not open when the resuscitation bag is squeezed. This allows the gas to escape rather than be directed to the patient.
A pneumatic (demand-valve) resuscitator is not recommended for use because it is difficult to control the delivered tidal volume and air tends to be forced into the patient's stomach.
B. Biphasic AEDs can analyze the rhythm in a moving vehicle.
B. providing bag-mask ventilation at a rate of 2 ventilations for every 30 compressions.
The width of the QRS in a patient presenting with tachycardia is .10 second. There are no clearly discernable P waves
within 45 minutes, the neuroimaging interpretation of the CT scan of the brain suggests an acute ischemic infarction. There is no signs of hemorrhage or mass lesions
3 hours. What is the maximum time from last known normal when endovascular therapy can be performed. 24 hours. What is the max time from last known normal when intra-arterial thrombolysis for select patients can be used for treatment.
The patient should be cooled to 32° C to 36° C for 24 hours
IV drugs given by bolus injection should be followed with a 20-mL bolus of IV fluid
The ECG monitor of a patient in the cardiac care unit after an MI indicates ventricular bigeminy with a rate of 50 beats/min. The nurse would anticipate
An examination of the rhythm strip reveals the following characteristics: atrial rate 74 beats/min and regular; ventricular rate 62 beats/min and irregular; P wave normal shape; PR interval lengthens progressively until a P wave is not conducted; QRS normal shape. The priority nursing intervention would be to
Lidocaine and amiodarone are used for ventricular tachycardia or ventricular fibrillation. Digoxin and procainamide are used for ventricular rate control. β-adrenergic blockers are used to slow heart rate, and dopamine is used to increase heart rate.)
Electrodes in the wrong lead will measure electricity in a different plane of the heart and may have a different wave form than expected. Stimulation of the vagus nerve fibers causes a decrease in heart rate, not artifact.) The nurse has obtained this rhythm strip from her patient's monitor.
If the sinoatrial (SA) node fails to discharge an impulse or discharges very slowly, a secondary pacemaker in the AV node is able to discharge at a rate of 30 to 40 times per minute. Lead placement for V1 includes one lead each for right arm, right leg, left arm, and left leg with the fifth lead on the fourth intercostal space to the right ...
d. a general anesthetic will be given to prevent the awareness of any "sudden cardiac death" experiences.
d. Avoid lifting arm on the side of the pacemaker above shoulder.
These algorithms involve ACLS events in in-hospital settings for anesthetic and surgically related pathophysiology. Thank you to Vivek K. Moitra, MD, Andrea Gabrielli, MD, Gerald A. Maccioli, MD, and Michael F. O’Connor for providing this to us. Printed with permission.
This reference document summarizes the drugs used for ACLS cases and their storage requirements. Last updated 2015-05-07