What is Asystole?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:
Like pulseless electrical activity (PEA), it’s also important to determine what may have caused the patient’s asystole, or in other words, examine the H’s and T’s. If you can figure out why the patient went into cardiac arrest, looking at the H’s and T’s will help you determine the possibility of treating any reversible causes of the asystole. The H’s and T’s are:
Treatment of asystole is not limited to the interventions outlined in the asystole algorithm. ACLS providers must attempt to identify and correct an underlying cause if one is present. Healthcare providers must stop and ask themselves, Why did this patient have this cardiac arrest at this time. It’s essential to search for and treat reversible causes of asystole in order for a healthcare provider’s resuscitative efforts to be successful. That is the role of the H’s and T’s in a nutshell: to identify conditions that could have contributed to their asystole. Asystole ECG ReadoutHeart rhythm: None Clinical SignificanceBased on the findings from the ECG readout above, it would appear that this patient is in asystole. Because there is no myocardial, electrical, or mechanical activity, there is no pulse and no circulation of blood and oxygen. Asystole TreatmentThe treatment of asystole consists of the following components:
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. Asystole Treatment Steps
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. 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. The decision to stop resuscitative efforts 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. What medications treat asystole?Standard drug therapy for asystole during cardiac arrest includes epinephrine, atropine, and calcium chloride (CaCl). Recent studies have shown that ventricular fibrillation (VF) can appear to be asystole when recorded from the chest surface.
Which is the most appropriate for the treatment of a patient in asystole?Asystole should be treated following the current American Heart Association BLS and ACLS guidelines. High-quality CPR is the mainstay of treatment and the most important predictor of a favorable outcome.
What is the correct treatment protocol for asystole?When treating asystole, epinephrine can be given as soon as possible but its administration should not delay initiation or continuation of CPR. After the initial dose, epinephrine is given every 3-5 minutes. Rhythm checks should be performed after 2 minutes (5 cycles) of CPR.
What are two ways asystole is treated?The only two drugs recommended or acceptable by the American Heart Association (AHA) for adults in asystole are epinephrine and vasopressin.
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