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]
Overview
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[1]
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 Q3-5min | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Rhythm | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Shockable | Non-shockable | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| ROSC(return of spontaneous circulation | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Post–Cardiac Arrest Care | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Do's
- Efficiency of CPR can be determined by
- Monitoring of chest compression rate and depth
- Adequacy of chest wall relaxation
- Length and duration of pauses in compression and number and depth of ventilations delivered
- Physiologic parameters; partial pressure of end-tidal CO2 [PETCO2], arterial pressure during the relaxation phase of chest compressions, central venous oxygen saturation [ScvO2]
- Remember that the foundation of successful ACLS is good BLS , represented in prompt high-quality CPR with minimal interruptions.[2][3]
- A new class I recommendation is the use of quantitative waveform capnography for confirmation and monitoring of endotracheal tube placement.
- Supraglottic advanced airways continues to be an alternative to endotracheal intubation for airway management during CPR.
Don'ts
- Don't routinely use cricoid pressure during airway management of patients in cardiac arrest.
- Don't routinely administer atropine in the management of pulseless asystole.
References
- ↑ Field JM, Hazinski MF, Sayre MR, Chameides L, Schexnayder SM, Hemphill R; et al. (2010). "Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 122 (18 Suppl 3): S640–56. doi:10.1161/CIRCULATIONAHA.110.970889. PMID 20956217.
- ↑ Edelson DP, Abella BS, Kramer-Johansen J, Wik L, Myklebust H, Barry AM; et al. (2006). "Effects of compression depth and pre-shock pauses predict defibrillation failure during cardiac arrest". Resuscitation. 71 (2): 137–45. doi:10.1016/j.resuscitation.2006.04.008. PMID 16982127.
- ↑ Eftestøl T, Sunde K, Steen PA (2002). "Effects of interrupting precordial compressions on the calculated probability of defibrillation success during out-of-hospital cardiac arrest". Circulation. 105 (19): 2270–3. PMID 12010909.